Medical School Mayhem

2011-02-26T15:55:00.000-08:00

Melena Shoes: $24.99
The medical school education that has allowed me to find humor like this hidden in everyday life: $200,000.
Having 'melena' come up in a conversation that doesn't end in, "OK, go do a DRE and get a guaiac.": Priceless.

Your Children Will Thank You

2010-07-04T13:37:00.000-07:00

for giving them names that are at least passably familiar, or that are spelled in accordance with the rules of English phonetics. This isn't a cheap shot at foreign names--rock on, little Ashwin from India and Toan from Vietnam--but as I have learned after 2 weeks in a certain pediatric emergency room, there are a lot of parents giving their children...creative names. This isn't a race or class thing either, so don't think I'm going after the LaKieshas and Dantaes (fact: the majority of the kids at my high school were African American, and in part because of that I know not one, not two, but three women named LaKiesha. Aaaaand so we see how novelty becomes the new conformity). So here are some tips/warnings/desperate pleas to assist you in naming your bundle of joy, so that when I walk into the room to see your child I don't have to a)mispronounce their name horrifically or b) say, "And who is this?" to slyly get you to pronounce your kid's name.

1. Spelling a name backwards is something fun to do in your 'special, secret diary'--you know, the one with the cheap lock you could break with 30 seconds and a hairpin--when you're twelve. But you're not twelve, and you're not writing about the bitchy girls at school who made fun of your troll earrings; you're naming a child. When I saw 'Samej'' on the screen in the ER it took me a second to realize the level of atrocity that had been committed. A few days later I saw not one but two Nevaehs (yes, it's 'Heaven' backwards; it's also juvenile forwards).

2. If there are more silent letters than there are letters that are pronounced...it's time to take a look at what you're doing. And though I realize that you're a good-hearted yuppie who wholeheartedly supports social welfare spending,this is not a depression-era public works project where the goal is to get as many letters involved as possible. This is a name. Kimberleigh, Carleaux, and Peaulleigh thank you in advance for sticking with Kimberly, Carlo and Polly.

3. Picking a random noun for a name is not acceptable. I know celebrities are doing it, but celebrities are also doing high colonics and that doesn't make those OK. Apple, Blanket, Sky...this is supposed to be a nursery, not a picnic. Even more egregious faux pas--naming a child after a consumer good, especially one that is...comment se dit? A trifle tacky. Pity poor Chablis and Chardonnay; pity Lexus and Alize even more.

4. Finally, the ones that have fifty potential pronunciations, and bear little relationship to any name you have previously encountered: Sajquanna, Jayreon, Mekhi, Keajah, Jniqua. This is obviously my problem, not theirs, but...I. don't. understand.

All of these are names I have seen in the past 2 weeks. I can only imagine what I might have gathered with more time on my hands.

If you're unsure about the name, try this test. Imagine the name substituted into the following three phrases:
"And now I present to you our CEO, (name) Smith."
"In other news, twenty-two year old (name) Smith was arrested this morning during a police raid on his/her meth lab."
"And now, on the center pole here at Jackson's Gentleman's club, (name)!"

If it works in the first, you're golden. If it sounds better in one of the other two, you might want to give it a little more thought.

And today...we learned the pelvic exam.

2010-02-26T19:05:00.000-08:00

First, there was the pelvic exam, which was largely demonstrated via a video (with the sound turned off) which an Ob/Gyn attending walked us through. It was odd sitting in a room with all these other people looking at a projected vagina larger than the lecturer's head.
Things learned, and fun quotes:
"So a few weeks ago my eighteen year old son, who is very dear and who's just begun dating, came to me and wanted to know about women's menstrual cycles...specifically how regular they are and what the implications are. And so, after I had a coronary and grabbed him and shook him until his fillings came loose..."

The 'inspection' portion of the exam, during which you inspect and palpate the external genitalia, went on FOREVER in the video. Quoth both Dr. W and Dr. S, "Don't ever stare at a woman's vulva for this long. I have no idea what's going on with this video...also, when doing the pelvic or breast exam, DO NOT make any comments on the patient's appearance. Not even compliments. ESPECIALLY not compliments. Especially if you don't want to get sued."

Put lube on your fingers, lube on the speculum...lube it all up. It won't interfere with Pap smear results, and it will make everyone more comfortable.

"Don't open the speculum until it's all the way in. Because if you get it halfway in, tentatively, and then open it up...(Every woman in the room winces and gasps). Yep, that's right. Every woman in here knows it. And guys, just imagine having something rammed up your urethra."

Be careful if you insert your finger before you insert the speculum...don't try to have too much stuff in there at once. Quoth Dr S, "There is a finite amount of space in most women's vaginas."
This is true--it's not like Santa's sack in there. It's not a clown car.

I was astounded the male GU and genital exams were actually demonstrated to us live. More on that after the jump.

Just a note

2010-02-09T16:02:00.000-08:00

I would just like to say a few things.
To the prof who put a picture of a puking pumpkin in the power point presentation on eating disorders: Real sensitive. You're on the list.

To my body in general: stop producing prostaglandins. To my uterus specifically: stop trying to claw your way out of my abdomen. It really, really hurts and makes it difficult for me to study.

To Amina, who taught me that the best treatment, if not cure, for dysmenorrhea is a combo of red wine, David Sedaris essays and Sade (Sha-DAY, the singer of 'Smooth Operator,' which I thought of every time someone mentioned the obturator nerve last year in anatomy...actually, I think of lots of inappropriate songs at inappropriate moments...for instance:
-Talking to one of my high school friends about how she finally stopped self-mutilating: 'The First Cut is the Deepest,' by Sheryl Crow
-When one of my acquaintances (who I didn't particularly like) got evicted in college: 'There's No Home for You Here' by the White Stripes
-Watching Ann Coulter on FoxNews: 'Evil and a Heathen' by...shit, what was that band that came to play at Cornell my junior year?
-Listening to an attractive member of the faculty discuss drug abuse and dependence: 'Addicted to Love'
-At the 'Get to Know your Administrators' lunch: 'Dean's Dream' by the Dead Milkmen
-Sitting in the lecture on treating sexual dysfunction: 'Limp' by Fiona Apple)

Damn that was a long parenthetical.

Oh, and to Fiona Apple, since I'm thinking of it: Thank you for your body of work. Please put out another album.

Psychiatric DDx

2010-01-29T22:57:00.001-08:00

During our psych small group discussion today, everyone kept forgetting that mental disorder due to substance abuse is part of EVERY differential diagnosis in psych.

I am hoping the following two words will burn into people's brains that drugs alone can make you completely, utterly, mother-freaking insane:

Amy. Winehouse.

You're welcome.

Great Quotes from Lectures Today...and a TV Show

2010-01-28T20:15:00.000-08:00

"I am not giving up. I never give up...I'm...transcending the situation." -Sheldon, from 'Big Bang Theory' (How I've felt about the past...approximately...week.)

"We finished that lecture a little early, so should we take an extra long break before the next one? There might be other people coming...What? Ok then, screw 'em." -Dr Z

"No, you don't want to give lorazepam to someone who's already intoxicated. They have a tendency to stop breathing." -another lecturer

"The appearance of oligodendrocytes on section is mostly due to artifact...but we're just neuropathologists, so a reproducible artifact is good enough for us." -yet another lecturer

Psych is not crap.

2010-01-23T22:14:00.000-08:00

Why is it that people...even other physicians...treat psychiatry like the Special Olympics of the medical specialties? "Oh, I have a cousin who's a psychologist!" (Psychiatrists are physicians. Psychologists--even those with PhDs--are not. Doctors, sometimes, but not physicians. Psychiatrists can prescribe drugs. Psychiatrists are required to complete medical school, residency, and generally fellowship. Psychologists go to graduate school, and are fantastic, gifted, and frequently delightful people, but they aren't doctors).
In the words of one of my instructors, when they heard I was interested in psych, "Oh, you guys have come a long way from the days of id, ego, superego...you're getting really...scientific now." He's an ID (infectious disease) guy, and I wanted to reply, "Yeah, and you guys don't believe in miasmas and evil humors anymore. Good job." So instead I said, "Yeah, I did research this summer using co-registered structural MRIs to perform volumetric analysis of paralimbic brain regions associated with early-onset major depressive disorder. It was pretty...scientific."
And we're doing psych now, and a lot of my classmates are talkin' smack. Not all of them, but a lot, and a number of folks have been pretty effing insensitive. So, for the record, I've had some psych issues myself--early onset, partially genetic, partially environmentally induced. Anxiety and severe depression. Life-shattering, oh-crap-it's-hospital-time depression. An eating disorder thrown in. And I'm not particularly ashamed of it. Know why? Because if more people were willing to admit these things, it might be normalized, and people would calm the hell down with the guilt trips--"Oh, I NEVER let myself get depressed. I just don't have time."
"Maybe if you stopped thinking of yourself and started thinking of other people you'd feel better."
"It's all in your head."
"Snap out of it."
"Pray harder and Jesus will heal you."
"Just eat something."

My views on psych meds are...complicated, and more suited for an extended essay than for this venue. But hey, just for fun, let's talk about how difficult it is to get yourself euthymic (ie, OK) on meds. It's hard. I've been sampling various medications since I was eleven, trying to 'get right,' and in that time, guess what I've taken? Oh, you don't have to ask, I'll tell you. *This is why I haven't had to go to many of the psychopharmacology lectures.*

Sertraline, venlafaxine, fluvoxamine, trazodone, lorazepam, alprazolam, clonazepam, valproic acid, gabapentin, mirtazapine, quetiapine, lamotrigine, lithium, topiramate, zolpidem, aripiprazole.
How many? 16, ladies and gentlemen. The majority of diabetics have an easier time managing their condition than I've had keeping this under control. And I don't even get any MedicAlert bling for my trouble.

Do It Now.

2010-01-01T19:11:00.000-08:00

I think I've made my views on this clear in the past, but you need to go get emergency contraception. Right now. Plan B is now available as a single pill. In the past, it was necessary to take two pills, twelve hours apart. This is a great step forward (anyone who thinks having to wait 12 hours to take a second pill is no big deal has never been, or had to deal with, someone who actually needed to use EC...the condom broke, or there was an assault, or there was a night of drunken irresponsibility, or whatever; waiting 12 hours to take the second pill and 'be done with it' can seem like torture).

It's available over the counter if you're over 17; with a prescription if you're younger. Buy some for yourself, and encourage your friends to do the same. If you have a teenaged daughter, take her to the doctor for a prescription and get it filled (assuming, of course, that if she's sexually active you've already been a responsible parent and taken her to an OB/Gyn to get on the Pill, had a long talk with her about the importance of taking charge of her own sexuality, only being sexual with someone when she's ready, not when some sixteen-year-old Lancelot starts panting about 'If you really loved me...' and, for the love of all that is holy, USING PROTECTION).

Oh, and obligatory myth-busting--EC doesn't cause an 'abortion.' In fact, it won't work if you're already pregnant. So, on this particular point, right-to-lifers--chill. Also, EC is safe--safer than aspirin (though the more I learn about NSAIDs in med school, the more terrified I am by the prospect of using ibuprofen, or aspirin, or any of those ilk anyway).

When/if the need arises, you'll be glad you have it in your medicine cabinet.

Exploding Stomachs

2010-01-01T18:27:00.001-08:00

...or, as a professional would say, 'gastric rupture.'
I was cleaning out our fridge and idly picked up the box of baking soda that's been in there for, oh, six months, and which is no longer absorbing odors (and which I rather suspect of harboring rogue odors of its own--the Yemen of my refrigerator). And as I looked at the box, you know how you do, I saw a paragraph on the back describing how one might use it as an antacid. Why, in the era of proton pump inhibitors, one would do this...well, it's cheap, I guess. But it also contains a buttload of sodium (yes, that's the SI unit of measure), and there was a severely worded, bold warning on the side of the box: TO AVOID SERIOUS INJURY, DO NOT TAKE UNTIL POWDER IS COMPLETELY DISSOLVED. IT IS VERY IMPORTANT NOT TO TAKE THIS PRODUCT WHEN OVERLY FULL FROM FOOD OR DRINK.

Being of the science-y persuasion, and remembering the vinegar and baking soda demonstration from fourth grade, I conjectured: Baking soda + stomach acid = internal volcano? But could a slug of baking soda after a big meal (and really, isn't that when you have indigestion anyway?) truly cause your stomach to explode? After a few minutes Googling around, I found my answer:

NM Downs, PA Stonebridge, Department of Surgery, Royal Infirmary,
Edinburgh. "Gastric rupture due to excessive sodium bicarbonate ingestion"
Scott. Med. J. 34(5) 534-5 (1989)

Around the same time, apparently (the late 1980s were evidently as bad for stomachs as they were for fashion), a young man in Denmark had a large meal of sausages and soda pop, took some sodium bicarb to help settle his tummy, and caused HIS. STOMACH. TO. EXPLODE. So be careful out there, kids. Even the most innocuous things, used in a--comment se dit?--stupid manner, can kill you. Pay the extra money for Prevacid--or (and here's a concept) don't eat so many sausages that you are literally at risk of rupturing your internal organs. Cheers!

Finals Week Poetry Breakdown

2009-12-15T19:32:00.000-08:00

Reflecting on this block's learning experiences, with a poetic form suited for each.

Pathology (the haiku, a form of infinite subtlety, that nonetheless comes down to just a handful of words--much like a path report).

Bridging necrosis
and Mallory's hyaline:
cirrhosis, but why?

Kill the eponyms?
But won't we hurt Cushing
and Virchow's feelings?

If I never see
One more liver biopsy
It won't make me sad.

Bullous pemphigoid
or mycosis fungoides?
Which one looks grosser?

Dermatology (couplets--short and sweet, and simple to write, just like prescriptions for Retin-A and steroid cream).

Your autoantibodies to desmoglein three
mean pemphigus vulgaris. Better you than me.

I'm sorry to inform you, your mole's cellular division
has crossed the line, and now it's time for a complete excision.

The necklace hubby bought you has given you a rash;
it's called contact dermatitis; next time, tell him, blow more cash.

(Especially for Dr. A. C. L. of dermatopath):
If the lesion is pigmented but the biopsy's a shave
expect at best an angry phone call and at worst an early grave.

Endocrine (Limericks--because everyone knows endocrinology is funny. Right? Um.)

A woman who hailed from Tacoma
had a sizable prolactinoma.
She started lactating,
but more devastating,
Her leg hair required a comb-a.

The doctor she saw told her, "Well,
I can see something wrong in your sell'
turcica--if you're keen,
Try this cabergoline,"
And she did, and it all turned out swell.

GI still to come...

African albinos

2009-12-04T23:35:00.000-08:00

Part of a physician's duty, one could argue, is to help protect the vulnerable--whether that means reporting child or elder abuse, ensuring informed consent, or preventing the possible leak of someone's HIV/AIDS status. Currently, health care workers (among other social service personnel) are busy in Tanzania, trying to provide safety and care for albino individuals. See here and here.

There are two main threats to albinos in East Africa: one is skin cancer (what happens when you take a phenotype already prone to cutaneous malignancy and add tropical doses of UV light); the other is 'poaching,' a term usually reserved for animals, but which seems to capture the brutality of the attacks on these people. Local...um...I don't think there's really a PC word for witch-doctor...local animist and Voudoun practitioners claim albino body parts are powerful charms for luck and riches; others use albino blood in their spells. The world is a wide and strange place. But lest we assume that these people are (to quote a commenter on one of the sites) "superstitious, bestial savages," let's remember that--killing aside--a lot of people in the US still wouldn't want to shake hands with an HIV positive person, or someone with psoriasis. Suprisingly, albinism is exponentially more common in Tanzania than in the US.

What got me started on this train of thought? Why, studying vitiligo for my dermatology exam, of course.

Basically, Everyone's Crazy

2009-12-02T18:17:00.000-08:00

It's like that song from Avenue Q, "Everyone's a Little Bit Racist."
Today we talked about 'functional somatic syndromes' in our doctorin' class. These are syndromes, ahem, "defined more by suffering and symptomology than by any consistently demonstrable pathophysiology." Which sounds a lot like saying "it's all in your head." Which, to me at least, sounds kind of paternalistic and dismissive--medicine as an entity and doctors in particular putting the burden of 'un-understandability' on the patient rather than admitting that Western medicine doesn't totally have its shit together with the whole mind-body connection. A little like hubris, I feel. In one of the articles we read for today, the authors listed 'side effects from silicone breast implants, irritable bowel syndrome, repetitive stress injury and vaginismus' as among these functional somatic syndromes. The paper was written ten years ago. In 2009, we have official diagnostic criteria for IBS and fibro; everyone and their sister knows that carpal tunnel DOES, in fact, exist; and I'm gonna go out on a limb here, but I doubt that even in 1999 a reasonably intelligent person would say, "Have 500 ccs of potentially allergenic, if not carcinogenic, material pumped into each of my breasts? Don't mind if I do!" As for vaginismus being an issue of mind over body--yeah, possibly, but that doesn't mean the suffering isn't real, and telling women to just relax about it doesn't address the problem. I guess what I'm saying is, we don't know everything there is to know about the world, and it's kind of pompous to say that if we don't, it's the world's fault. After all, just 50 years ago doctors were still telling women that dysmenorrhea was all in their collective heads (and had, apparently, been a form of mass female hysteria since time immemorial).

Our group leader described his thought processes well--when prescribing a tricyclic antidepressant for a woman with irritable bowel, it's common to be met with the dismayed cry, "Doctor, you think I'm crazy! I'm not crazy!" At which point he then points out, "Your gut is very special--it's the only organ system that has a complex 'brain' of its own...(explain about the enteric nervous system, neurotransmitters, la ti da ti da) and I think that these drugs, even though they were originally prescribed for depression, might have some usefulness here." Meanwhile, he says, 'I'm thinking, yeah, I do think you're a little bit crazy, but so's everyone.' So that's a nice message to keep in mind next time someone's acting like a whack job and being really frustrating--everyone has their own particular flavor of crazy. It's like the world is a huge Baskin-Robins, but with neurosis instead of ice cream.

Healthcare professionals make the worst patients

2009-11-30T17:08:00.000-08:00

So after the heady delight of yesterday's clear liquid diet and colonoscopy prep (read the details here, if you're inclined--it included 1) a grand total of 17 trips to the bathroom, 2) the drinking of 2 liters of a substance whose foulness could probably be approximated by mixing together 2 liters unsweetened lemonade, a cup of salt, and a few tablespoons of rancid butter, 3) my internal organs producing rumblings and gurgles more commonly associated with active volcanoes and hot springs)--came the event itself. The things I remember, after the glorious sedative/miracle that is Versed:

1) The anesthesiologist was kind of a jerk. Not mean; just not real heavy on the people skills. Example: "Did you eat or drink anything today?" "Yes, some diet coke. A few ounces." "When?" "To take my Synthroid this morning..." (interruption) "I said when, not why." Maybe I'm hypersensitive, but slow your roll there, Dr. Feelgood. I flushed a little bit at this--because hey, I'm here in a 2-ply paper gown about to have someone spelunking in my colon; I'm worried about my own asshole, so I don't want to worry about what you've got wedged up yours right now. "You've got a sort of rash on your chest. Have you noticed that?" Poking my chest, checking to see if it blanches...poke, poke, poke. Hey, why not ask before you start prodding? Just a thought. And I'm flushed because I'm pissed off but I'm not good at verbalizing anger.

2) The nurses were awesome, as nurses usually are. Warm blankets, and this hose that essentially blew warm air through the blankets I had on to keep me toasty while I waited. Someday I'm going to make friends with a medical supply rep and get one of those for my house. Or, you know, an electric blanket. Probably cheaper.
There was one bit of an awkward moment--the nurse was explaining things to me in that reassuring way that nurses have, while I was looking at the pulse oximetry reading and trying to consciously lower my heart rate to sub-tachycardic levels (have I mentioned I'm kind of tightly wound? And that I've been obsessed with controlling my heart rate and blood pressure since I read an article on biofeedback in sixth grade?). "And you can just relax--we'll have machines to keep track of your heart and your breathing, and the doctor will give you some medicine to make you nice and sleepy...now what grade did you say you were in?" (I'd mentioned being a student.) "I'm a second year medical student."

3)Apparently the doctor came into the recovery room and explained everything, but damned if I remember anything. Thanks again, Versed!

Nazi doctors: read with caution

2009-11-17T19:04:00.000-08:00

A lot of what I write is relatively...light in nature. I've been told I'm funny, at least (which is better than just being funny-looking--what I'd be left with otherwise). Recently, though, the question of just what the ethical standards of physicianship are has come up at WUSM. There was a presentation on the atrocities perpetrated by the Nazi 'doctors' (I put doctors in quotes because those who so demonstrate so clear and complete an absence of conscience, so utter a disregard for humanity and decency, no longer deserve the title), and--understandably--there has been some upset, mostly related to some not-so-sensitive questions that were asked afterwards. Namely, whether the Nazi doctors were subjected to peer pressure, and whether this in part explained their actions. I will add that I was not at this talk, and so am at best dealing with secondhand information about said upset...realistically more like third or fourth-hand, with the attendant reliability issues that entails. Nevertheless, this seemed like fertile ground for exploration, and something about which I must make my opinion known.

As most people (I hope?) know, the Nazis' crimes against humanity included 'medical experimentation' conducted chiefly by 'Drs.' Josef Mengele [Auschwitz, all manner of horrors], Carl Clauberg [Auschwitz, both forced sterilization and forced impregnation, ie rape], Sigmund Rascher [Dachau, especially high-altitude and hypothermia experiments], and--killing any naive belief one might have that women are always nurturing and incapable of such vile inhumanity--Herta Oberheuser [Ravensbrueck, creating 'battle wounds' and infecting them with gangrene and staph]. To call their undertakings 'research' is to defile both that word and the memories of those who were tortured. Mengele is perhaps the most infamous of these doctors; his experiments, particularly on twins, are the stuff of nightmares. He injected solvents into twins' eyes in attempts to alter their color, performed surgeries--like intestinal resections--without anesthesia, and allegedly attempted to 'create' conjoined twins by sewing a pair of Romani twins together. These are not the acts of a scientist, however depraved, and they are most certainly not the actions of a physician. They are what happens when an already sick individual is given such power that his perversion becomes florid, all-consuming, utter. They are what happens when a psychopath is not subject to the slightest judicial or societal restraint.

I've known about these things since middle school, when the Holocaust was first mentioned in our history classes and I found myself appalled that such things could have happened; not so much that Germans 'allowed' it to happen (there is something to be said for what someone does under duress, the ways in which a totalitarian state twists the mind and the soul--read Alice Miller for an in-depth exploration of this from a psychoanalytic perspective). Reading and hearing about them has an effect on everyone merely by virtue of their humanity: it is impossible not to be repulsed. As a medical student I find that my response, while essentially the same, is still more profound.

As a physician-in-training (not even yet a doctor) I took an oath on the day I got my white coat; more importantly, I made a promise to myself and to the world when I chose healing as a profession. I swore that above all, I would do no harm; that I would always put the needs of my patients foremost. I promised that I would act with humanity, compassion, and humility, and that I would work for the preservation of human life and dignity. There are circumstances in which this is not easy--when, indeed, it might even seem unfair. As a specialist in Jewish medical ethics said at a talk I once attended, if a terrorist and three of his victims come into your ER, and the terrorist is triaged at a higher level than the victims, he gets care first (ideally, of course, everyone's getting it at the same time). Or, to paraphrase a little-heard B-side of Alanis Morissette's, if a man's in the emergency room with a bleeding head because he was beating his kid and she hit him back...you still stitch up Dad's head. WITH adequate anesthetic (not, of course, that I would think of doing it any other way).
L'olam lo suv. Never again.

Day of Diarrhea

2009-11-11T18:54:00.000-08:00

Laugh, if you must. After 6 hours of lecture and small groups devoted to the intricacies of the human bowels, I certainly did. Maybe I was a little slap-happy, getting back in the swing of things after an entire (gasp!) 48 hours sans studying--but by the last hour of lecture yesterday, I was seeing double-entendres everywhere.

"There are two etiologic categories for diarrhea. Number one isn't that important, but number two..." *Snicker*

"There is a wide range of frequencies for bowel movements." (Display of an actual GRAPH of the number of bowel movements per day--in case you were wondering, 'normal' runs from three times a day to three times a week, and the median is once a day.) "As you can see, the graph peaks at once a day, and sort of tapers at either end." *Hee hee*

"Diarrhea is frustrating to diagnose, but it usually comes out all right at the end." *Further laughter, and the recognition that I have the maturity of a fifth-grader.*

Awards

2009-11-02T21:33:00.000-08:00

Today we had the 'Distinguished Service Teaching Awards' at school. Which mostly translated into 'free reception snackies and diet Coke...and alcohol, but no alcohol for you, because you're trying to cram another hundred renal facts into your cranial vault in the next twelve hours, and champagne will not help you do that.' So, in the spirit of such awards, let's hear it for The Body Systems, Organs, Diseases, and General Medical Stuff Awards! Yay! (Sponsored by Valtrex).

Most alarming symptom that's usually fine: Rectal bleeding. Notice I'm NOT a doctor, but rectal bleeding, especially when accompanied by pain, is usually hemorrhoids--and you'll usually be fine in a couple days if you get your hands (well, not your hands exactly...) on some hydrocortisone suppositories. Yes, suddenly being confronted with unexpected blood--particularly from this region--is distressing (as I *almost* said to my physician when she asked 'how much' bleeding I was having, "I don't think there's an acceptable lower limit for ass blood"), but it's nowhere near as bad as, say, vomiting blood.

Most innocuous condition that makes me wish I were dead: It's a tie between menstrual cramps and migraines, both of which feel like I have tiny angry elves inside my body trying to hack their way out with pickaxes. Sometimes I get both at once (oh joy! It's fairly common, apparently, and has to do with all those shifting lady hormones), and all I can do is stay perfectly still in my dark, dark, bedroom with earplugs in and a heating pad on. Oh, and take Ultram. I don't think it's a narcotic...

Grossest-looking infection that is in no way dangerous: Onychomycosis, or for those playing the home game, fungal infections of the nail bed. The thing is, it's not limited to people with poor hygeine, either...sometimes you'll be at the pool and some cute little twentysomething will walk by and only when you look down do you notice that she has, not to put too fine a point on it, toenails like corn chips. Fritos.

Prettiest-sounding infection that's actually quite gross: Chlamydia.

Most recent disease to be stripped of eponym status: Wegener's Granulomatosis, now ANCA+ vasculitis or granulomatosis (because it turns out Dr. Wegener was a Nazi, which is actually really not cool).

Laziest 'organ'- The appendix. Yeah, that's right, I put organ in scare quotes.

Overachieving organ: The liver. It does everything. If you've been reading this blog for any length of time you know my love of the liver is vast.

Organ so large and in charge you don't even think of it as an organ: The brain. More than a traditional dish in the zombie-American community; it's what keeps everything running smoothly.

Quotes from Urology Lectures

2009-10-30T21:13:00.000-07:00

First, I wonder what urologists tell people they do at parties. It seems like one of those areas of employment where, despite the fact that it took over twenty years of schooling to attain, you might be tempted to...well, not embellish the truth. Not embroider it, certainly...but, perhaps, omit. "I'm a doctor," you'd say, or a surgeon. I'm in men's health, maybe. Because otherwise there will be jokes, almost certainly of questionable quality, and the teller will probably think he's the first one ever to think of something so hilarious, and you'll get thrown out of the party when you finally succumb to temptation and punch him in his damn mouth. That said, some quotes from our urology lectures.

"It's very important to find out what kind of sexual dysfunction a man's experiencing before you just send him home with Viagra. Because if the problem is anorgasmia, and he's been taking 30 minutes to get things done, and you give him a vasodilator-- well, not only will you not solve his problem, but when he's now going 60 or 70 minutes, his wife is going to come looking for you. Probably with a gun."

"The commonest problem in young men is actually not ED--it's...(pause for answers, all of which--interestingly enough--were provided by the women of the class) premature ejaculation, that's right. And you're going to have to ask about it, because I can guarantee you, no one ever comes into the office and says, 'Can you help me, doc? I'm a premature ejaculator.'"

"Men will tell you that they use recreational drugs to treat their ED. Listen, guys: Pot and coke don't make it easier to maintain an erection or anything like that. You just don't remember the erections you aren't having."

Things I learned this week, and some quotes

2009-10-08T18:31:00.000-07:00

1. "In a differential diagnosis, include the 'mosts.' The most common, the most dangerous, and the most interesting. Though in the case of acute chest pain, skip the most interesting. Because if someone has ST elevation on their EKG and you're talking to the resident about parasitic pericarditis, they're going to hit you with the clipboard. And so they should."

2. "Speaking as an internist, every last one of you in this room has a pulmonary embolism until proven otherwise. That is something you never ever want to miss."

3. Apparently there is an outlet for my hypochondria and tendency to catastrophize: unleash it on my patients! "Put in the differential the absolute worst things it could be...the really bad shit. Because you'd feel really bad if the patient died and you had to say, 'Oh, a pneumothorax...I never thought of that!'"

4. 'If a little is good, a lot is better' does not apply to high-fiber cereal bars, no matter how tasty they may be. Remember that SNL spoof about 'Colon Blow' cereal? Back when SNL was funny? Yeah.

5. Physicians, especially ER docs, really seem to relish catching malingerers. Their eyes always light up when they talk about it, and they start grinning like feral chipmunks. For instance, someone complaining of chest pain angling for MI-type attention who says it hurts when you press *right there* is probably faking it. That's musculoskeletal. "I always tell them, oh, good, I think you're out of the woods. Peace."

6. Having whacked out hormone levels (though not, as of yet, any confirmed $%&# diagnosis) has made me a little...hairier than usual. Supposedly acne is also part of the sideshow. "At least I don't have that," I consoled myself. Wrong. Long workouts + androgens + ubiquitous bacteria = not just acne but, cruelly, ass-ne. *Is there no end to the ignominy?!?!*

7. My first hospital session (with an actual patient) is next week. I'm a little (ok, a lot) nervous. Hopefully I will not blind the patient with the ophthalmoscope or forget part of the physical or lose my train of thought during the history and just sit there staring blankly. No. All will be well.

Does she or doesn't she?

2009-10-04T19:24:00.000-07:00

Only her reproductive endocrinologist knows for sure.

The 'so, do I have PCOS?' circus continues. Altered hormone levels, especially high androgens (male hormones)? Check. Irregular periods? Check. Increased (ahem) body hair? Yeah, fine, check. Obesity? Well...no, but the comorbid eating disorder could have something to do with that. So what's the most distressing? Honestly, the hair (this from someone who hasn't shaved since middle school). I feel like I'm either going through puberty again or turning into a wolf. Or possibly both. Wasn't there a book during the eighties called 'I was a teenage werewolf?' I think there was.

Americans have really...effed up responses to female body hair. When I wear shorts, I catch people staring. A lot. I wish, if they were really that curious, that they'd have the testicular fortitude (ie balls) to come up to me and say, "Hey, I think your particular style of bodily presentation is really different and kind of cool. Would you tell me a little bit about why you do things this way?" Then I might not want to disembowel them with a spoon for tee-heeing with their friends behind my back at the Metro stop. Y'know, the way I do now.

In a 1998 study, 125 undergrads of both sexes were shown 2 videos of a woman drying off after a swim. In one she was clean shaven, and in the other she had hairy armpits and legs. The unshaven woman was rated as less: moral (?!?), relaxed and fun; she was rated as more assertive, aggressive, serious and 'in better physical condition.' This was the same woman, mind you. The only difference was the presence vs. absence of hair.

A few days ago, on what I generally consider to be a feminist blog, one of the commenters (in discussing her feelings about fat acceptance vs. fatphobia) brought up the subject of choosing with whom one associates, and said, "For instance, I think women have the right not to shave if they don't want to, but I still think it's abnormal and weird and I probably wouldn't want to spend a lot of time with them." REALLY? AYFKM? (Think it out...Are You F*cking Kidding Me?) Just having looked at me, without so much as a hello, you know you don't want to chill with me based on the state of my hair follicles? Not to mention that it's NORMAL for women to have body hair--IT GROWS THERE AND WILL BE THERE UNLESS YOU ACTIVELY REMOVE IT--and so the whole "It's abnormal/weird" argument is proof positive that you've bought into the consumerist/patriarchal/western beauty complex.

The excess hair associated with PCOS is called 'hirsutism,' and it really isn't so much an excess of hair (though it can be) as it is a male-pattern hair growth--ie, on the chest, the lower stomach, the shoulders, upper lip and chin, lower back. Most people bleach it/electrolyze it/shave it. Some people, like Circus Amok performance artist Jennifer Miller (google it...you'll like it) don't. It's all part of the pulchritudinous plethora of personalities we call life. So for now, I'm going to discreetly pluck a few places...and leave the rest.

Fun quotes from the past week

2009-09-21T18:16:00.000-07:00

Pulmonary lecturer: "If there's blood in the pleural space, obviously the lung can't expand there. Two bodies cannot occupy the same space at the same time...though, of course, it's fun to try."

Renal lecturer: "So if this woman has 6 liters of extra fluid on board but she doesn't have pitting edema, where did she put it?"
Student: "I don't know, in her hump?" (full disclosure, it was me.)
Professor: "What?"
Other student: "She's a camel!"

Other renal lecturer: "And if you had to guess which diuretic Peter Griffin from Family Guy is on, you would guess spironolactone. Because of the gynecomastia." (For those playing the home game, gynecomastia is when men develop hypertrophic breast tissue; in layman's terms, man-boobs).

Today's Lessons...

2009-09-16T21:38:00.000-07:00

Not necessarily related to class--though some are.

1. No one ever has pheochromocytomas (tumors that produce excess adrenaline and noradrenaline), but lots of people have the symptoms. The symptoms are really common and vague--palpitations, flushing, jitteriness. As an intern, you will run lots of labs trying to track down a "pheo," imagining the 'House'-ready moment when you present your off-the-wall find to your attending and are crowned with laurels and fanned with palm leaves by the more junior medical students. One problem: you will not find them. They are the Easter Bunny, the end of the rainbow. Never there. Oh, and fun learning point: "Pheo" is a root meaning 'dusky.' Guess the tumors are dusky colored.

2. According to several people in my class, "Snickers are the healthiest candy bar. The most protein, the most fiber. No, seriously." I would say that if your eating habits have reached the point that you are SERIOUSLY considering the nutritional merits of Snickers bars, you have bigger problems than that extra 2 grams of fiber can address.

3. Not even the promise of cupcakes was sufficient to lure--I mean, encourage--more than 5 people to come to the Medical Students for Choice meeting. Why? Because another interest group was having a meeting and serving lunch. Since when does lunch beat cupcakes? Especially cupcakes with that layer of frosting that's so thick and firm you can pick it off the pastry and eat it by itself? Damn, now I'm all hungry.

4. In low-bloodflow situations, tissues (including the heart!) are capable of entering a 'hibernating' state where oxygen need is reduced and metabolism slows; upon reperfusion (ie the return of blood to the area) metabolism picks right up again, albeit with modifications--including modifications that are protective in the event of future ischemia! We are truly adaptable creatures.

5. I'm a soprano and all, but hitting a high A (as in, a ledger line above the staff) is...difficult.

6. When you're a medical student, you dissect the aorta and appreciate how thick it is, how muscular while still being elastic and distensible. When the aorta dissects itself--as in advanced syphilis or Marfan's syndrome--it's really, really bad. Rupture and exsanguinate (isn't that a great word? Better than 'bleed out,' in my opinion) in a matter of minutes bad.

7. Waiting for 45 minutes at the reproductive endocrinologist's office with only a People mazagine for company reinforced several things I already know about myself:
a) I think those over-sized sunglasses are a horrible, horrible trend, mostly because I associate them with Paris Hilton and Mary Kate Olsen. Also, they make people look like bugs.
b) I am a fundamentally impatient person. I have a need to be doing SOMEthing at all times. Maybe the Universe is teaching me to be more chill; I don't know.
c) I am out of touch with popular culture, and this does not bother me. I know who Jon and Kate are solely from check-out-stand magazines; I do not care about their family because I have other things to care about, and also because I am strangely immune to the 'cuteness rays' children emit. I spend evenings reading textbooks and writing sonnets rather than watching TV. Does this make me a better person than someone who watches Wheel of Fortune or streams cat videos on YouTube? Yes. Yes, it does.
d) There is no way to make a gyn exam not suck. There are, however, ways to make it suck less--and the rules for an easy exam are surprisingly similar to the rules for good sex. To the patient: relax. Speak up if something hurts. Breathe. For the doctor: Go slow. Explain what you'll be doing before you do it. Warm the speculum, or use a plastic one. Have lube handy. Don't be in a rush, but don't hang out in there forever.

More on Fat Acceptance...

2009-09-08T00:19:00.000-07:00

Great article on eating disorders in the Fat Acceptance movement from my absolute favorite magazine, Bitch: Feminist Response to Pop Culture.
An article which begs the question, what exactly makes an eating disorder? Obviously it's a subjective diagnosis, whether you're talking about anorexia or binge eating disorder (yes, there are 'physical,' objective indicators of eating disorder status...a BMI below 17.5, or amenorrhea for more than 3 months for anorexia, for example) but then again, even the DSM-IV includes "overvaluation" of weight as a symptom of EDs. Think about that. In 2009, in the United States, one could reasonably argue that most women 'overvalue' their weight. Not because we're stupid or shallow or have a diagnosable eating disorder, but rather because that's what we're trained to do from elementary school on. Despite the positive spate of articles in teen-oriented magazines like Seventeen, there are still 'Summer Tone-Up Specials' published every May, showing 13 year olds that the best (and perhaps only) way to be a real woman is to watch those calories and do 100 crunches a day.
We have a slew of television shows like 'Bulging Brides' (I almost fell off the treadmill at the gym when I saw that title a few days ago) and 'The Biggest Loser' that focus exclusively on weight loss. Magazines at the check-out stand offer ways to drop 20 pounds in a month--assuming that every woman wants or needs to lose the equivalent of a small child--then, in another article a few pages later, exhort women to love themselves whatever their shape. Then, in the 'Health' column, another admonition that a body fat percentage over 20 means you're headed for an early, deep-fried grave. The whole mess is--well, a mess.
The primary point is that eating disorders occur in people of all shapes and sizes--something that most people would benefit from knowing. Officially, anorexia requires a certain percentage of weight be lost--yet I've known 'normal' and overweight people who followed profoundly restrictive diets. For a period during college, I was running ten miles a day and eating 600 calories--but it wasn't until my weight plummeted past 100 lbs that I was 'officially' anorexic. Bulimics can be any weight. Someone can binge-eat and weight 80 pounds, or 380. The fat acceptance movement is right on in encouraging people to care for their bodies--but an eating disorder, whether manifest in starving or bingeing, is profoundly unloving. For a woman attempting to heal that damage to be rejected by the very movement that purports to champion body-love is both counterproductive and disappointing. Exclusion and derision hurt, no matter what the 'political' motivations.

Cool stuff learned in class this week

2009-09-05T20:15:00.000-07:00

1. If you have 2 boys, roughly 13 years of age, show up together in the ER with symptoms of atropine poisoning (anticholinergic or antimuscarinic poisoning): Odds are good--ie, 90%--they heard from someone--like a 14 year old boy--that it's possible to get high by smoking a plant called Jimson Weed. The bad news is, it contains alkaloids related to those found in Atropa belladonna (otherwise known as deadly nightshade) that will make your mucous membranes dry, make you unable to pee, cause hyperthermia (ie, high temperature, but not mediated by the cellular messengers that usually cause fever), and make you kind of delirious and crazy. It's a high, sure, but it's not the nice sort of high you get from a Purple Haze or a White Widow (names, apparently, of carefully cultivated and very expensive varietals of Cannabis sativa. Ahem. Seriously, I read about it in a New Yorker article. And then learned about 'Afternoon Delight' from Arrested Development. Aside: I really don't know why marijuana isn't legal. It's exponentially safer than cigarettes, alcohol--or, for that matter, aspirin).
2. Two teen girls who show up together will probably exhibit an anticholinergic toxidrome related to motion-sickness meds (hey, if you take enough Benadryl or scopolamine you can get high!) or a sympathomimetic toxidrome (ie, be speedy, with pounding hearts and anxiety) related to drugs like amphetamines taken for weight loss.
3. There is a drug called Narcan which exists to bring people out of heroin-induced comas, but according to the lecturer, "People are usually pretty pissed off when they wake up, because you've undone the nice high they paid for."
4. There is a drug called Flumenazil that exists to undo benzodiazepine toxicity, too, but it's used much less often, and for good reason. If someone's been abusing (or even just taking regularly, as one might for insomnia or anxiety disorders) benzos, they'll be kicked into withdrawal, one sign of which is seizure. And what's the first-line treatment for seizure? Benzos, only know you can't use them, because you've blocked the receptor. Oh shit.
5. Despite having to memorize lots of drugs and mechanisms, pharmacology is pretty damn cool.
6. Pediatric neck masses are almost never cancer. In older adults, they almost always are.
7. If someone says they feel like they're 'spinning,' 90% of the time they have an inner ear problem.

A physician-to-be looks at Fat Pride

2009-08-31T19:07:00.000-07:00

There is a movement called Fat Pride. Marilyn Wann, the author of a book of fat activist essays entitled "Fat?So!" is widely considered to be at the forefront. It supports taking back the word 'fat,' just as the gay rights movement has taken back 'queer,' stripping it of its shameful and painful connotations. As one of my fat activist friends explained to me, "I'm fat. So what? I could say I'm Rubenesque, or generously proportioned, built for comfort and not for speed. But to the rest of the world I'm fat. Why dance around it?"
At a medical school, of course, we are taught that fat (dietary or bodily) is anathema (for those readers who majored in biochemistry and haven't read anything but Cell since sophomore year, anathema means really really bad). Virtually every lecture touches upon it in some way, from last year's biochem lecturer who seemed almost pathologically obsessed with saturated and trans fats (she cut one of her favorite baked goods out of her life entirely when she discovered they contained what I believe was 2 g of trans fat per serving--but then I speak as the person who has a hang up about fiber, which is no less pathological, and has me tallying my 25 grams a day in my daily planner)...to this year's pathology talks on cancer, in which dietary fat intake presents significant increases in malignancy risk. Obesity is a risk factor for cancer, for heart disease, for type II diabetes...yes. This is true. But there are other findings which are not discussed, and furthermore--and more disturbingly, to my mind--there is an atmosphere of...distaste for the obese that permeates our education, and which has no place in the training of future caregivers.
For one (yes, I should cite the study. Go to pubmed, and I have no doubt you'll be able to find it. I know saying 'A study said' without further citation is the gravest sin a scientist can commit. Mea maxima culpa) when overweight but cardiovascularly fit, exercising individuals and 'normal weight' but unfit individuals were tracked for seven years in a longitudinal study...the normal weight couch potatoes were at a higher risk of death. Interesting. Granted, in a social milieu that fosters sedentary life and cheerfully offers to Supersize everything, poor eating habits and inactivity often come together and produce someone who is unhealthy--and who also happens, through the normal workings of thermodynamics, to be overweight. But are all overweight people snarfing deep-fried Oreos and calling Guitar Hero their 'cardio for the day'? Of course not. Look, Grasshopper, and you will see...shades of grey. Yes, I know I spelled it the British way. I like that way better.
As for the distaste for fat people--which we medicalize and sanitize by calling 'overweight or obesity'--that is a much more malignant issue. My medical school class is not a cross-section of society by any means, perhaps most especially (and I find this intriguing) not in terms of body habitus, nor in health habits. Almost a dozen of us--out of 124--ran the St. Louis Marathon last year; many others ran the half-marathon. Today in class, I watched the snacks people were eating: four apples, one bag of carrots/celery, one bag of trail mix, a banana, and numerous diet Cokes. And as for body size, well, we are FAR below the widely cited "1 in 3" obesity statistic. Approaching, in fact, 0%. Perhaps that makes it easy for us to think of the obese as "them": it's something that happens to other people, something from which we (with our daily workouts and carefully planned 1800 calorie, low fat, high-fiber diets) are saved by our superior willpower.
I worry about this.
I worry that this will create physicians who think that nagging, insulting, preaching or condescending will get people to lose weight.
I worry that this will create physicians who think 'fat people' are to blame for all their health problems and are undeserving of sympathy and empathy.
I worry that we haven't found a way to help people who want to lose weight but can't, and that this may be partly because we think fat is a moral failing.
I worry.

Love/Hate

2009-08-24T22:55:00.000-07:00

It's that time of the month again...time for things (and people) that piss me off, the Medical Edition! And, because I'm trying to remain positive this year, there will be an equally important Things I Like section.

Things That Piss Me Off
1. When a doctor orders six separate blood tests, and they are tests that need to be done on different Vacutainers of blood, so that I have to give six tubes of blood instead of one. This isn't anyone's fault, per se, it's just one of those things that can't be helped. Also, when the phlebotomist has a hard time finding a vein and rather than WITHDRAWING the needle and trying again, just digs around under the skin...it's an awful feeling. I've drawn blood before, and I've had lots of blood drawn, and it's easier for everyone just to retry.

2. The paper gown. Just when you thought it was impossible for the hospital gown to get any draftier or less comfortable, they've traded in that cloth gown (which, despite being 3 sizes too big, at least provided you with a sense of being somewhat clothed) for one made out of Charmin. No, not even Charmin. Whatever the Aldi brand of toilet paper is, in 1/2 ply.

3. The fact that, despite being gay and despite having been celibate for longer than I care to mention, one of the first several questions any physician will ask me is, "When was your last menstrual period?" Even if I come in for chronic sinusitis. I'm not pregnant, I promise. Or, as I told the X-ray tech the last time I had a chest X-ray, "If I'm pregnant my girlfriend has a lot of explaining to do."

4. That the only medication that has considerably improved my insomnia gives me a hangover effect that keeps me from full consciousness until about noon the next day. During last year's finals, I was 45 minutes late for our Genetics exam because said drug kept me from responding to the alarm. I cycled through 2 anxiety attacks on the way (run!) to class, and got the extreme evil eye from the professor. It's nice to make friends with faculty members who are also in positions of authority within the school at large (ie, if you're going to be late for someone's exam, try not to make it one of the Deans'. Ooops). Thanks, Seroquel!

5. Male gynecologists. I'm sure they're nice people. I know several. I'm probably being sexist. But I don't want a Mormon bartender, I don't want a mechanic who's never driven a car, and I don't want someone without breasts or ovaries examining mine.

Things I like
1. Bandaids with cartoon characters. Call me childish, but Hello Kitty bandages really do make those minor abrasions hurt less.

2. Zyrtec. Can I get a hallelujah from all those with allergies? Zyrtec has made spring and summer enjoyable again. No, I'm not getting paid to say that.

3. Eugenol, or oil of cloves. I had a dry socket (otherwise known as the most painful condition humankind is heir to, outside of childbirth and kidney stones) once, and within seconds of having it packed with eugenol-soaked gauze, the pain was gone. I wanted to kiss the dentist on his big bald head.

4. Ativan. The ultimate anxiolytic, though its usefulness is limited by the fact that it generally leaves me too gorked to perform daily functions. It seems to work as most benzodiazepines do--ie, on the assumption that you can't have a panic attack if you're unconscious.

2009-08-21T20:53:00.000-07:00

Fun stuff: Wegener's granulomatosis.

When someone has had what seems like allergic rhinitis for fifty thousand years, despite pouring on the Flonase and all but mainlining cetirizine, one begins (if one is as obsessed with rare diseases as I am) to think about Wegener's granulomatosis. It's an inflammatory condition--not a cancer, not an allergy--that eventually leads to extensive vasculitis (ie, inflammation of the blood vessels). It can cause problems especially in highly vascular organs--kidneys and lungs particularly. On microscopic examination, clumps of white blood cells are visible: granulomas. Hence the name.

However, there's now pressure to rename the disorder, in part because eponyms don't actually tell you very much about the condition itself (though I have to say the alternative proposed in this case--ANCA-related granulomatous vasculitis--doesn't tell me much more) and also because of Dr. Wegener's past. Apparently he was wanted by Polish officials after the end of WWII. Apparently he was, for at least a short period of time, associated with the operation of the eugenically-minded killfest that was Lodz in the late 30s.

How do I know this? Because the aforementionedly awesome Dr. W. brought it up in class.
"Haven't you heard Dr. L's tirade about this?" she asked one of the co-instructors. "I remember hearing him go on and on about this Nazi granulomatosis." Which made me imagine clumps of white blood cells wearing little olive drab uniforms and goose-stepping all over the body.

Excessive Awesomeness

2009-08-19T19:04:00.001-07:00

I thought our first day back in the saddle with 'Practice of Medicine' would be the same old routine. Nope. The coursemaster (actually, coursemistress...is it more or less PC to call her that?) contributed greatly to the overall awesomeness. So sharp she might cut somebody--and she also appears to have an exquisitely low bullshit tolerance, so she might cut somebody for being inane, too. Which, I will be frank, I like. There was a brief discussion of how to comport ourselves out on the floors, including the admonition to take out the facial piercings and cover the tattoos. Also--and you'd think this wouldn't be an issue at our institution, but alas, it apparently comes up--to be well-groomed and hygienic. To quote Dr. W (all my Ithaca pals are laughing because that's the name of the Wegmans store-brand diet Dr. Pepper I drank by the liter all through college):

"Every year a resident gets the dubious honor of talking to one of the house officers about grooming issues. My favorite ever was, 'J, please wear underwear.' You do not want to be that person."
Mother of God. I can't even imagine the situation in which that talk became necessary. I can see "please don't wear any more leather miniskirts," I can see "please wear an appropriately-sized belt to prevent us seeing your 'Sizzling Scarlet' lace g-string," I can even see "If you're going to wear short skirts, cross your legs when you sit down." But...no underwear? In a hospital? Definitely not hygienic.

and so it begins.

2009-08-16T19:43:00.000-07:00

As it turned out, today's orientation chat was in fact a mere 30 minutes in duration, due in part to the absence of one of the deans (who was settling her daughter in at college...which, actually, is pretty sweet and indicative of good priorities). Additionally, it was very un-fire and brimstone: the admonition that yes, there are grades this year, was followed by an assurance that it is indeed possible for everyone to receive an 'Honors' grade in every class, as there's no curve. The acknowledgment that Boards will be upon us in less than a year's time was alloyed with the assurance that if we take them in June we'll have more than ample time to study, and a gentle chiding that it really is in our best interest to take them then (although our school, strangely, does not require us to take the USMLE; you'd think they'd want everyone to go get liscensed, but whatever) because you're REALLY not going to remember that stuff about the pentose phosphate pathway three years out from biochem. We have to register, or more accurately register TO register, in September. Getting your test date set is apparently a multipartite and esoteric ordeal, which may or may not involve setting up a bank account in the Canary Islands and/or painting the last four digits of your SSN in blood on the carpet of the registrar's office at midnight (bonus: Since this IS a medical school, the blood doesn't have to be your own, as long as you use universal precautions while handling it. As a vegetarian I'm allowed to use beet juice).

The laid-backness of the talk (which did not meet my expectations--but in a good way) was primarily due to the fact that it was Dean K giving it. All our deans are pretty chill, and indeed in all cases nice people that I wouldn't mind having drinks with, but I'll just come out and admit that I think Dean K is the bee's knees. When I've had occasion to deal with her, she's been fantastic. She's unbelievably helpful and grounded; one of those rare people that exudes NICE while also giving the impression that she is exhaustively competent and would not hesistate, if it became necessary, to kick serious ass (which here comes in the guise of the 'professionalism concern form'): in fact, not a bad role model.

The real deal starts tomorrow. Pharmacodynamics. Frankly, I'm a little scared by the sheer quantity of material it looks like we'll be covering in lecture tomorrow. We're in the army now!

Parenthetical remark count: 5

Things'll be different, baby. Promise.

2009-08-15T19:32:00.001-07:00

So the new school year starts on Monday, and tomorrow we have our one and a half-hour 'second year orientation,' which the class ahead of us has said is basically 90 minutes of having the fear of God put into us...ie, this year we have real grades, this year even more is expected of us, no more messing around, no more procrastinating and trying to cram everything in two days before the exams, etc. A sort of preemptive strike against laziness; a preventive spanking.
Problem is: this is what I have going through my head 24/7, in stereo and at a volume setting of 11 (out of 10). Do I really need to have the shit scared out of me to do a good job? Especially when I'm already, so to speak, flowing in that direction? Now we have Honors, High Pass, Pass and...*Not a Pass* as grading options, rather than the previous Pass/Fail. Of course, I'm going to shoot for all Honors, but do I need to go to Gunner Attitude Boot Camp tomorrow to get ready for the coming year? Maybe I'll have a little Xanax before I go... Am I high strung? Pas de tout.

And this year it'll be different. Not so much with the studying (I studied a fair amount last year, and didn't generally put things off...just tried to stay on track, rather than trying to learn a semester's worth of material in three days like some people I know...who shall of course remain nameless), but with life. A balance. Social activities, studying, exercising, and perhaps most pertinent for those reading this: blogging. I'm going to update this site, if not daily, then at least 4x a week. Hopefully there will be hilarious hijinks to recount, poignant moments to share, and my strange mix of hippy-dippy idealism and cynical misanthropy to vent. Join the fun!

This first 'block' of courses includes
Pathology, ie: 'When stuff goes wrong,' or 'Looking at the process of disease' or 'The Microscope's Revenge: The Return of Histology--this time it's nasty.'

Pharmacology, or 'Yes, we can make even DRUGS monumentally un-fun. Who remembers what gets processed using Phytochrome 450? Or perhaps more trickily, what doesn't? Hands? Tell me the difference between adrenergics and cholinergics and be smart about it!'

and Otolaryngology, or "The only lecture you're really going to remember is the one about things kids have stuffed up their noses."

Why does everyone hate vegetarians???

2009-05-19T22:00:00.000-07:00

So I've been invited out for dinner tomorrow night, and the woman doing the asking sent me a list of possible locations. Being the Type-A foodie that I am, I of course check the web sites (and pdf menus--what did those with food neuroses do before the InterWebz?) of all the restaurants and find that 1) They're all pretty expensive, which makes me...uncomfortable, and 2) My menu options are sorely and sadly limited (though not, to be fair, at the Indian place she mentioned).
What is it with Americans and the insatiable meatlust? Grrr.

Abstinence Only?

2009-05-16T19:40:00.000-07:00

So, thank God, Bush is no longer in the White House...but abstinence only education is still mandated in much of the US by state law. There are still abstinence-only government sites up on the web, too...the most interesting of which is 4parents.gov, which offers help in talking to your kid "early and often about waiting to have sex." Waiting till when? Til 18? 21? Whatever the age of consent is in your state (it's 14 in Missouri, and in some states as low as 12, to which I can only say...ew)? Til they're paying their own mortgage? No, silly...until their state-sanctioned, Judeo-Christian marriage! Which means that if I'm going to wait to have sex, I'll have to hold out until I have enough money to get my ass to Vermont (oh, wait--I could just go to Iowa, but then I'd have to live there permanently, because my marriage wouldn't be recognized in Missouri! Oh Joy!).

4Parents.gov also talks about the 'emotional' risks of early sexual involvement...for instance, girls who have sex, do drugs or drink are more likely to be depressed (first, this seems like a chicken/egg situation, and second, um, it seems a little...odd to put doing meth and doin' the nasty in the same category). Obviously, a middle-schooler isn't emotionally prepared for the sequelae of going all the way...but they're still going to, and perhaps it would be better to talk about REALISTIC ways to protect themselves--being assertive about their boundaries, using condoms and birth control, having sex with peers rather than falling for exploitive 'relationships' with older teens/adults--than to act as if the Magic Wand of Abstinence can make all these issues disappear.

Speaking of, apparently Bristol Palin and Jamie-Lynn Spears are working with the Candie's Foundation (I thought they sold shoes...WTF?) advocating--I kid you not--abstinence. Because, you know, it worked so well for them. So here's the real deal: Abstinence-only education and signing of chastity pledges generally does delay the age at which teens have their first intercourse (obviously we're talking hetero, lingam-in-yoni here). BUT when they do finally break down/give in to Satan/get coerced/whatever, they're less likely to use protection. And y'know what? The fact that you waited until you were 17 doesn't make you any less pregnant or any less infected if you don't use a condom.

The Level of Discourse

2009-04-24T17:46:00.000-07:00

During our most recent "Practice of Medicine" small-group session, we were discussing interventions for a hypothetical obese pediatric patient. We started off OK, as we generally do, but it only took a few moments for people's real feelings about the issue to make themselves apparent. Let me make something very clear: I love my classmates, I really do; and I have great respect for the vast majority of them. However, even estimable people sometimes believe (and vocalize) less-than-estimable things.
Within ten minutes, we had gone from using the terms "obese" and "overweight" to 'fat;' within fifteen, 'fatty' and 'Porky' had been thrown out (I regret to say that our faculty preceptor was among those to use those epithets, though admittedly in jest). I felt like my head was going to explode, showering my tablemates with gray matter, if I didn't say something.

I raised my hand, and as calmly as I could, said that I would explain the need for change to the patient/family by emphasizing the importance of healthy eating habits and healthy exercise routines, and not necessarily focusing on weight or a need to slim down (In fact, in all but a few cases, it's best to try and keep overweight children's weights STABLE, and let them grow into their 'extra' weight--ie, let a 100 pound fourth grader become a 100 pound sixth grader; no weight loss necessary). I also said, through more or less clenched teeth, that I was not entirely comfortable with the level of discourse in the room, and that placing undue emphasis on weight rather than healthy behaviors could encourage or 'set off' an unhealthy relationship with food, particularly in girls. Another student (a guy!) agreed, and mentioned self-esteem issues, eating disorders, cutting--all those uglinesses that derive from body hatred. "We're going downhill fast!" the preceptor exclaimed, to general laughter, at which point I all but jumped on the table and said,
"We're acting as if precipitating an eating disorder is a remote possibility, as if an authority figure's judgement of a young person's physique carries no value. It does. Yes, there is an obesity epidemic. One in three kids is overweight. But by the time they reach college age, between one-tenth and one-quarter of women have an eating disorder. This isn't coming out of left field."

After this the preceptor sort of propitiated me, saying that in his experience girls with eating disorders actually start out slightly overweight. We reined ourselves in a little bit. I was still struck, however, by how glibly we treated what is for many people a lifelong and seemingly unwinnable struggle against weight issues, and how we assumed that obesity is largely the result of laziness and gluttony--how quickly we turned a medical issue into a moral one, patting ourselves on the back for eating five servings of veggies a day and deriding those who cannot, as we can, run five miles a day. I wanted to say that actually, having had an eating disorder for more than half my life, it would be much healthier for me to have carried around an extra twenty or even thirty pounds than to have done all the things I've done over the years (and still, unfortunately, do sometimes) to control my weight--things that have lead to arrythmias and seizures, things that have screwed with my reproductive and skeletal systems, and most importantly, with my brain. As students at one of the top medical schools in the country (as we are repeatedly reminded), we have a responsibility to become competent physicians not only in the realms of diagnosis and hard science, but in the realms of ethics and communication as well.

A to Z of Rare Medical Words

2009-04-07T17:33:00.000-07:00

Words I didn't know before I started medical school...in alphabetical order (kewl).

anastamosis-communication between blood vessels

basilar artery-artery located (surprise!) at the base of the brain

Christmas disease-no shit, there really is a Christmas disease. Wouldn't it suck to have to tell someone, "Yes, you have Christmas disease...not Chanukah disease, not Ramadan or Holi disease...Christmas disease. Well, there's your present. Happy holidays." It's a sex-linked hemorrhagic disorder.

decidua--not related to trees; it's a kind of tissue found in the uterus.

enkephalin-a naturally occuring opiate, a la the endorphins.

falx-a sickle-shaped structure, a la the falx cerebri (look it up).

gastrocnemius-the big muscle in your calf.

hapten-a small, separable part of an antigen (look it up again).

imbrication-layers of overlapping tissues in a sutured wound. Use it in an everyday conversation and I'll pay you twenty dollars.

jake leg-paralysis caused by drinking improperly distilled liquor (not related to jimmy leg, which means--I dunno, actually, but it sounds bad. Oh, wait--according to the internet, it's Restless Legs Syndrome).

kallikrein- a vasodilatory peptide, ie, a molecule that dilates blood vessels.

labrum-a ring of cartilage attached to the rim of a joint. But doesn't it sound like a dirty word?

mediastinum- the space between the pleura of the lungs, where the heart is. So, y'know, home isn't where the heart is--the mediastinum is where the heart is.

natriuresis- When you piss away salt. Ie, when your urine contains too much sodium.

obtunded-passed out, to the extent that you don't feel pain when exposed to noxious stimuli.

palmaris longus- a superficial muscle of the forearm.

quinsy- an abcess around the tonsils. Seriously, there aren't a lot of words, period, that start with q, let alone medical words I didn't know before.

reamer-a dental instrument. Yes, it is in fact called that. Didn't you always feel like you were getting reamed at the dentist's?

Saint Louis encephalitis- a viral encephalitis named after the city in which I am now going to medical school. Normally you can't get that kind of deal without getting your MD in a tropical location.

tardive-the adjectival form of lateness. A fancier way to say tardiness-ness, I guess.

unctuous-fatty or oily; One of the side effects of Alli is unctuous anal leakage.

vasa vasorum-literally, vessels to vessels; the small blood vessels that supply the walls of larger arteries or veins.

Wharton's jelly-a form of connective tissue in the umbilical cord that, obviously, has a jellylike consistency. Impossible to eat on toast without vomiting afterward.

Yaws-a tropical infection of pretty much every tissue in your body, caused by a spirochete. Ew.

Zonule of Zinn- double credit! The suspensory ligament of the lens of the eye.

Hope you had fun! I know I did!

Snoezelen!

2009-03-21T19:56:00.001-07:00

Snoezelen rooms have recently come to my attention (actually, they came to my attention a year or so ago when I had a woman from my church tell me she thought I had a sensory integration disorder...make of that what you will, but there is the fact that I tend to be very sensitive to hyperstimulation. I do OK with things generally, which is good since 3rd and 4th year will basically be defined by 'hyperstimulation.').
They are simply these soothing, gentle rooms designed to help chill out people with developmental disorders, with a smorgasbord of subtle, calming sensory experiences available for the client who's using the room. They've been studied in this capacity, and actually appear to work for autism and Alzheimer's Disease (though of course a double-blind randomized controlled trial isn't possible in this case, which leads me to wonder if perhaps we don't need an alternate paradigm for assigning validity to studies; not a complete overhaul, just some new ways of looking at things that aren't so "pill vs. placebo"-centric). I really want one, or to spend some time in one, maybe...There are dim lights, but also things to look at--from my webcrawling it appears tropical fish tanks are popular--tactile experiences like padded walls (no jokes, please), pillows, satin and chenille throws; auditory experiences like soft music or the sound of rain or a babbling brook; Sometimes it's even possible to incorporate smells.
In the meantime I suppose I'll make do by lighting a tuberose candle, covering my lamp with a scarf, and wrapping myself in my fleece throw. It's not the same, but it'll have to do.

quitting, and the placenta.

2009-02-12T19:22:00.001-08:00

One of my classmates was able to witness the miracle of birth today ("Not as much screaming as I expected" was the general jist). What really freaked her out was not the birth itself, but the afterbirth--that's right, the placenta. "It was just this big...thing," she said, her eyes wide. "This mush. It was this big--" she spread her hands, as if demonstrating the size of a prize catch--"And just purple-y and huge and..." Obviously a terrifying thing.

I discussed this with my roommate, a NICU nurse, who concurred. "They aren't pretty. They never show it in movies, either," she said, her brows furrowed. "It's always just, yay, a pretty baby. No placenta. Sometimes when there's something wrong with the baby or the mother, they send it along to the NICU in a bag," she added. "Usually they're nice about it and put it in a black bag so we don't have to look at it. When the fellows come they're always really excited about it, too, because then they can send it to pathology." She shuddered.

The word itself comes from the Greek for "plate" via the Latin for "cake," both emphasizing the fact that the placenta's pretty flat. I've tried several times to link an image, but screw it. Look it up on Wikipedia; there are several images, some gorier than others.

I am updating in part to fill the time I would ordinarily be spending smoking. Also because I have been relentlessly badgered by a certain person whose name starts with a G and ends with an inder. Oh! So, a random recap of today's events, which may be elaborated in a later post:

Today we had the only dental lecture we will ever get in med school. Saw many images of periodontal disease, thrush, malocclusion and canker sores. Take home message: Brush. Floss. Use fluoride rinse if you have to. Just because you're smoking meth every five minutes doesn't mean you can't maintain a basic oral hygeine regime (although admittedly there are other factors at play in the development of 'meth mouth.' If you've never had the pleasure of seeing manifestations of that malady, please do google it, though not if you are eating, have recently eaten, or are planning on eating again, ever). Other take-home message: don't be afraid to get a dental consult, because as a physician one of the few areas of the body you are NOT required to know jack shit about = teeth (Note how I used the equal sign to avoid making a mistake in subject-verb agreement in the previous sentence. Is? Are? Is 'teeth' the antecedent or is 'one'? Because teeth are, but one is. Sorry. Grammar Gestapo.)

I wore my lucky turtle socks today, a gift from a college roommate, and subsequently discovered I'd gotten an honorable mention in the William Carlos Williams Poetry contest (a poetry competition for medical students). Now I just have to get the registrar to affirm that I am, in fact, a student at Wash-U med--because, according to the woman I spoke to on the phone, there was an 'unfortunate incident' several years ago. Erm. Go lucky turtle socks! My precious...

As far as quitting goes, I have my patch on. I have been chewing gum like crazy. Sugarless gum. The gum that warns you that "excessive consumption may have a laxative effect on susceptible individuals." Apparently I am a susceptible individual. Apparently I have also been consuming excessively. And now I am doing other things excessively as well. So that's fun.

Honestly, I think the patch is giving me a bigger dose of nicotine than I got when I was smoking, because I feel really revved up. For instance, I'm not tired right now at all, and I'm normally positively geriatric when it comes to bedtime (at least since I started taking Seroquel, the only thing that has EVER worked to KO my chronic insomnia...though I know one person in my class is achieving similar feats with codeine cough syrup. Meh. There have to be SOME benefits to being sick; I say ride the gravy train as far as you can if you're unfortunate enough to come down with something nasty). Also. Since the PI I wrote to earlier this month hasn't emailed me back, I am now expanding my horizons and sending out my CV to other PIs (that's 'principal investigators,' or 'people who are kind and generous enough to let me come work in their lab for the summer'). Also. I have been cunningly crafting Valentines all week and will spring them on the unsuspecting in the days to come.

Yesterday I had another MRI, of my ankle this time. Stress fracture. Big fun. Hopefully all will be healed in time for the marathon in April. If not, I may have to do the half instead, and I will be disappointed. Sad face.

Ok, I'm gonna do ID instead.

2009-01-22T18:32:00.000-08:00

What's ID, you ask? It's more than what I get asked for every time I want to see a rated-R movie or buy a pack of cigs (My for-real, I'm in an American Lung Association sponsored smoking cessation class quit date is Feb 3rd--wish me luck. In the interim, the woman at the corner store-- with what are apparently the early signs of dementia--asks me every single time, "What are you, in middle school?" No, ma'am. Just flat-chested and baby-faced. Moisturize, and you too could be mistaken for half your age!). It's Infectious Disease, y'all, and it's super cool.

Did you know there are more microbes in and on your body than there are cells that belong to you? So even if you're an atheist, or agnostic, or on a desert island...you're REALLY never alone. I know it's weird, but it's sort of a comforting thought. You, by yourself, are a community--an ecosphere all your own!

There are lots of microbes that live happily with you and don't cause any disease...it's called commensalism, or mutualism. Actually some bacteria even feed you--making Vitamin K in your intestines, for example. Others live on your skin and keep bad guys like MRSA (the nasty 'superbug' that's been in the news lately) from taking over...like your own little bacterial bouncer patrol.

And even bad bugs--enterococci that cause gastritis, para ejemplo--have some mechanisms of action that are truly amazing (sort of like how you hate the Bond villain in every movie but are frankly amazed at the intricacy and detail of his/her evil schemes): E. coli can actually get INTO your bladder cells and chill out there, evading detection. You get treated for a UTI, all the 'outside' bacteria are wiped out, but then there are these little 'seeds' of e. coli lying dormant-ish, waiting, and then BAM! Even though you haven't been reinoculated (ie, you haven't gotten more bacteria into your bladder by having sex and not peeing afterwards, or wiping back-to-front, or wearing tight pants, or whatever else is on the 'not-to-do' list these days) you're reinfected. Whoa. Take that, Mr. Bond.

Also, staphylococcus aureus is named that because 'aureus' is from the (Latin?) root for gold...y'know, Au? Remember the periodic table, kids?...and when you plate them out, the colonies are a brilliant gold color that's frankly stunning. I know I'm going to earn some weird looks for this, but especially when they're plated on blood agar, the contrasting colors are spectacular. I'd put a picture of that up in my living room, with the caveat that no one be allowed to ask what it is.

PS--No, I'm still totally married to psych, but ID is definitely, undeniably enthralling.

It's the sarcasm patrol!

2009-01-19T17:01:00.000-08:00

So this has been an awesome weekend.

Got an email from the doctor saying, yeah, we need to do an MRI. To check for--no shit!--a brain tumor.
Had a respiratory physiology take-home exam.
Couldn't start my car Saturday because it was too cold and the gas line had frozen up.
Went outside today to discover that someone had broken into my f*cking car.
And this week looks to be like a baguette--long and hard (well, maybe not AS long, since it's only 4 days).

Seriously, God. Not cool.

Breasts!

2009-01-08T18:07:00.000-08:00

Knew that would get your attention. Anyway, it always gets mine.
But no, this is not about mammary glands, not really. Instead it's about the respiratory exam, which we learned to do today, and the delicate art of intergender examinations.
When we finally got up to our practice rooms to attempt the arts of "inspection, palpation, and auscultation" on one another (that sequence has been effectively drilled into my head now--thanks, Dr. R!) the question arose: same gender dyads to practice, or opposite, or both? As the preceptor said, "I know that for practice's sake it might be better to pair off male/female...but for comfort's sake, you'd probably rather do same-gender exams, right? Well, you've got five more years of practice ahead of you, so for now let's stick with comfort and do same-gender pairs." It's odd; everyone in the class knows what my orientation is (I think) but to date this hasn't caused any awkwardness, for which I am profoundly thankful. It's hard enough trying to learn how to percuss and listen for inspiratory splitting without worrying that your exam partner thinks you're surreptitiously trying to cop a feel. Which, it goes without saying (and for once I'm not being sarcastic) I would neeeeeever do, for approximately 573 reasons, among them professionalism, integrity, the fact that a lot of the women in my class could kick my ass if I tried such a thing, and the fact that I'm really not into the whole sexual assault business.

I was surprised, but the guys actually seemed more uptight about the idea of examining women than we did about the prospect of being palpated by gentlemen (and in fact all the men in my practice group are what I would call gentlemen). "I mean, how do you do the exam...with women?" one of the guys asked. To which our preceptor--a funny guy who I am 99.9% positive is gay, and whom I thus had no qualms about allowing to demonstrate part of the exam on me--said, "Well, the breasts are always going to be there." We all laughed at that, but it's true; I've never really been conscious of it, because I'd only ever been on the receiving end of physical exams before, and with my 32AAs there isn't much concern about impeding the progress of a physical (though there was the nurse who took an EKG and left my gown wide open until I yanked it closed...I was not pleased), but breasts can be cumbersome when you're trying to do a cardiac or respiratory exam. You may have to ask a woman to lift or move her breast, or if she can't, gently do it yourself. We're just learning about all this, so we still get awkward and blushy and worry that someone's going to be pissed at us. By third year, apparently, mammaries will be mammaries will be mammaries. It's all in the approach, I guess, in how the body is constructed and understood from a cultural perspective (and medicine--medical school especially--is definitely its own culture).

Learning to laugh at my own stupidity--and Microbes!

2009-01-07T21:02:00.000-08:00

So I slept essentially...not at all last night (ok, 5 hours) and that was from 4:30 to 9:30. That may not seem like much of a shortcoming to you late-night IMers and Conan O'Brien watchers (yes, I realize I just sounded like a geriatric patient, and secretly I am a 87 year old woman--you kids quit playing grabass on the lawn!), but I've got me some bipolar disorder, and I need my damn sleep. So I was not running on all however-many cylinders today, as became immediately (or, unfortunately, not-so-immediately) apparent when I went to pick up some essentials at the grocery store today. Never mind that the grocery store is kind of a fraught place for me, or that I have a rough time actually picking things up and putting them in the cart, or that I always feel like I'm in 15 different people's way...beyond all that intrinsic neurosis, I got to the check-out counter FINALLY, and when all was said and done...I didn't have my credit card with me. Got it out of my wallet to do God-knows-what with it and never put it back in, and had all of $7 in cash with me. So I did the whole stammering/turning red/sweating/sympathetic nervous system in overdrive thing, y'know, where you wish the earth would open up and swallow you down to the bowels of hell where at least you could hang out and drink absinthe with Oscar Wilde. So I muttered an apology and all but ran out the front door, my face a color somewhere between "rose" and "carmine" in the Martha Stewart interior decorating palette. Once I was home and finishing the last of a bottle of merlot I could look back at it and laugh, because it is sort of a ridiculous situation for a person who's obsessed with doing everything perfectly and never incoveniencing anyone to find herself in. Maybe I'm learning, little by little, to laugh at my shortcomings--at least those that don't kill anyone (please, please, universe, don't let there be any of the other kind!).
Also, had Microbes today for the first time, and it was so utterly kewl. We got a pack of these Microbe Cards to augment our learning process...like Pokemon or sports trading cards, with images of the infectious fungi, bacteria, viruses, or parasites in question on one side and information (from epidemiology to diagnosis to treatment) on the opposite side. I'm really looking forward to getting together a microbe card playing league..."I play N. gonorrhea!" "I play Cipro!" or "I play Hepatitis C!" "I play interferon!" Gonna be a +3 infectious disease specialist by the end (Note: I have never actually participated in an RPG and thus have no idea what I'm talking about...except for the microbes. I kind of know what I'm talking about there, but only to such an extent that I can sound reasonably intelligent at cocktail parties and probably be very dangerous to actual patients, which is why I'm not yet allowed in the same room with them without an M.D. chaperone).

No fumare

2009-01-04T16:53:00.000-08:00

No smoking in...Italian, maybe?
Did you know nicotine is more addictive than heroin by most objective measures?
I did. And I'm trying to quit despite that knowledge. I went cold turkey once before, in college, and didn't smoke for 6 months...then stupidly, oh-so-stupidly, started again.
So right now, as I'm quitting (not trying to quit--quitting) I could kill someone--maybe myself, maybe an innocent bystander--with a spoon.
And so I was actually on the edge of breaking down and going to the corner store to get some nic sticks/coffin nails/ciggies/fags/whatever you call them, only to find (yeah, ha ha ha, Universe, really hilarious) that my ID is temporarily MIA. So no dice. This, to me, is a coincidence--but it's also an example of the Goddess saying, "You promised you were going to quit. Now sit your ass down and do some deep breathing." What a lesson in surrender.
Mysterious ways, indeed. I can't shake the feeling that Divinity has pinched my driver's license. Luckily I walk to school.

So much for one major religion, then.

2008-12-17T19:23:00.000-08:00

Examine your prejudices.

So I guess I can't be Catholic. The Vatican recently released "On the Dignity of Persons"--in Latin, of course, to make it sound cooler--in which Cardinal Ratzinger (he'll always be Cardinal Ratzinger to me, because it sounds so much more appropriate than Pope Benedict...which just sounds like a sacreligious breakfast dish) decried stem cell research and the morning-after pill as the harbingers of the end times. Well, not exactly, but he called them both mortal sins, ie Very Bad Things.

Here's the thing. The morning after pill prevents implantation of the (potential) embryo, which at that point is (if anything) a collection of several cells--like, literally less than 100. (See, Dr. C, I paid attention during your embryology lectures!) It doesn't kill it. It keeps it from glomming onto the uterus, which is what happens more than 50% of the time anyway. It isn't abortion (which I'm also not saying is wrong...but that's a whole 'nother kettle of fish), so even if you're opposed to abortion, you don't have to be against the morning-after pill.

I honestly think every woman who's begun to menstruate should have the morning-after pill, or a prescription for it, in her medicine cabinet (well, actually in her dresser drawer, since the temperature fluctuations and humidity in the bathroom could screw with the drug). Am I saying everyone should be out not using contraception? C'mon now, don't you know me better than that? Sometimes contraceptive methods fail. Sometimes the condom breaks. Sometimes you realize the next morning that, yeah, you were both really drunk and didn't use one, and after saying a few mea culpas and vowing never to be that irresponsible again, you need something else to do. In short, life happens, ergo shit happens.

But (hold on while I get out my soapbox...) EVEN IF you're one of those who thinks heathen young women having sex out of wedlock should have to "face the consequences" of their actions (yes, person purportedly so concerned about an unborn child's wellbeing, let's think of the kid as a 'consequence' rather than a person--do you not see the intrinsic cognitive dissonance there? And let's not even get me started about the heathen young men who get off scot-free, morally speaking, because boys will be boys...) those aren't the only people who use the morning after pill. Here I will insert a

**Self-disclosure alert**

I have used the morning-after pill. If I were ever in the same situation again, I would use it again without hesitation, even knowing the side effects (it made me so nauseous I had to go get another prescription to replace the one I'd urped up, as well as a few hits of promethazine--ie Phenergan, an antiemetic that had the nice fringe benefit of making me tired enough not to care if I was feeling vomitous). I was raped my freshman year of college. September of my freshman year of college. The only thing that could have made it a more fantastic start to my academic career? If I had gotten pregnant. I realize most people dismiss this as The Extreme Example, but honestly it's not as rare as you'd think; 25% of college-age women experience rape or attempted rape at some point during their schooling.

If my God/Divinity/Ultimate Reality required a young woman to carry her rapist's baby, I would look for another one. Or maybe I'd talk to Her directly and see what She had to say, rather than getting it secondhand from a lifelong-celibate male (ahem).

Fears and Vindication

2008-12-15T18:14:00.000-08:00

Finals are upon us. A time of trepidation, of fear, but also of vindication.
The holidays are also upon us; likewise, a time of mingled despair and delight.

What am I afraid of? Unreasonably afraid of?
I am afraid of failure, but more than that I am afraid of mediocrity.
Less existentially, I am afraid of food poisoning--I've only had it once, but it left a lasting impression. Salmonella and e. coli especially.
I am afraid of never finding "the One"--the person to spend the rest of my life with.
I am afraid of flying.
Spiders.
Failing medical school and having to live in a box under a bridge.
That I will never be truly happy, because I'll never really know what that even looks like.
That everyone else knows what they're doing, and I somehow missed picking up the secret instruction book that the rest of the world is reading from.
Cancer.

What am I proud of, vindicated about?
That two of my finals are over, and I passed them.
That I've survived this long in one piece (it's been a bigger task than you might think).
That I'm blogging again.
That for the most part I manage to prevent myself from indulging in sophomoric navel-gazing like this.

What about you?

I know I am a medical student because

2008-11-25T20:14:00.000-08:00

I get nearly 100% of my fluids from caffeinated beverages.

I have gone out drinking after an anatomy exam...at 11 in the morning.

I spend more time on my cadaver's body on a given day than I do on my own in roughly a week.

I have skipped class...in order to study.

I have learned so many mnemonic devices, I have trouble keeping them all straight (and they all have to do with drinking or sex--especially the ones I've written for myself).

I can now eat a meal while discussing dissection technique (and in fact did so on Sunday night...thanks for the dinner and calvaria-removal talk, Dr. Ginder!)

I have realized that while showers can wait, and laundry can wait, anatomy waits for no man (or woman).

I have had dreams about the brachial plexus.

I have come, after almost a semester of medical school, to realize that I have more to learn than I could ever have previously fathomed. This is both very humbling and terribly exciting.

I don't wanna.

2008-11-13T05:43:00.000-08:00

Anatomy exam 2 came and went. I did better on this exam than I did on the last one, which pleases me, but not as well as I would have liked (of course, anything less than a 100 is 'not as well as I would have liked,' given my inherent OCDish-perfectionist tendencies, so this is somewhat less than surprising). So the limbs are done. And the pelvis, and the perineum. On to the head and neck! Onward and upward to the Circle of Willis, I say! And on to a biochem quiz!

One problem.
I don't wanna.

Woke up at 3:30 this morning, couldn't get back to sleep, and I don't wanna. Don't want to go to my PCP preceptor's office this afternoon; don't want to study for my biochem exam (though I have been, don't get me wrong); don't want to learn physiology or biochemistry this morning. And yet I will do all these things. Because that is what adulthood in general, and professional school specifically, is about. Mostly doing things that you're excited about, but on some days, when you just want to stay in bed and look at cuteoverload.com or maybe watch an Eddie Izzard DVD or finish that painting you've been putting off...going into lecture or lab anyway. Bleargh.

When do political issues become medical issues?

2008-11-06T01:11:00.000-08:00

And I'm not even talking about health plans here. I'll leave aside for a moment tax credits vs. Medicare-for-all vs. universal employer coverage (which, by the way, still isn't analogous to universal coverage). I'm thinking specifically about the recent outcomes of Prop 8 in California (to ban same-sex couples from getting married), and of the Arkansas vote to prevent unmarried couples, gay or straight, from adopting children.
Now, you might say it's a good thing for children to be raised in intact homes. That's true. There are, however, intact and loving homes that haven't been marked with the state's official seal of approval (ie, a marriage license). Add to that the fact that the parents in some intact and loving homes, by virtue of legislation like Proposition 8 in CA, can NEVER become married--and the fact that various agency representatives in AR have said they basically intend to look the other way on the marriage issue "as long as they ain't queers or nothin'" (OK, so I've dramatized a bit) and you have a message of hate masquerading as concern for child welfare, which makes an already regrettable attitude downright despicable.
Am I saying this on account of the fact that I--at some point in my adolescence--'caught the gay?' Well, yeah, in part. But I'm also saying it because I know gay parents who have only managed to be legally recognized as the parents of their offspring through processes like second-parent adoption, and this sort of law threatens the ability of my tribe to create families. So what's second-parent adoption, you ask? Essentially, Mary and Alice are a couple. Mary gets artificially inseminated, maybe with Alice's egg to make the experience more equally 'shared'--but also a damned sight more confusing. So, Mary gives birth to the baby and is thus listed on the birth certificate. But, lo and behold, there's only space for one parent of each sex on the birth certificate, so Alice is S.O.L. until she secures a second-parent adoption, which establishes her as another mother. OK, I lied, it's not actually that confusing--just frustrating and lame.

So let's say (Goddess forbid) something happens to Mary, and there's no adoption, and no marriage. Well, if Mary listed Alice as the child's next guardian, it's all OK (well, not really, because if Mary's parents don't like it, they can contest it in court and in Arkansas chances are they'd win) and the right person ends up with the kid. But if Mary hasn't made a will? If she hasn't been thinking about her mortality, if her death wasn't anticipated, and she accidentally steps out in front of the 29 bus some morning? It would be nice to say that Alice, as the child's de facto other mother, would automatically get custody...but it would only be nice to say, because it wouldn't be true. Mary and Junior are both injured in a car accident and both incapacitated? Guess what--if they live in the wrong state and Alice hasn't officially been invested with healthcare decision-making power for her partner, Alice can't legally make medical decisions for either one of them.

That's when political issues become medical issues, and why a physician with the best interest of the patient at heart must be aware of both.

Who says there's no fun allowed in med school?

2008-11-02T11:44:00.000-08:00

Quotables from the most recent set of lectures

"You can in fact exercise your pubococcygeus muscles. There are exercises called Kegels, and the best thing about them is that no one knows you're doing them...you can stand at the podium and contract them as you're lecturing, for example, and no one has any idea." --Our very funny anatomy prof with an AMAZING British accent

"There are many theories as to why humans evolved bipedal locomotion. To see cheetahs in high grass and avoid being eaten; to be able to wade into water to fish without drowning; to be at the right level to harvest grain. My personal opinion is that it evolved to enable us to drink Bud Light. Try drinking from a can while on all fours sometime...maybe after you've had a couple already. Very difficult. Hence, bipedalism."--Another anatomy prof in a stunning nonsequitor

(On trans fats) "What did you guys have for breakfast? Any McDonalds? How about a glazed doughnut? No? What did you have?"
Student: "Cottage cheese and a bagel."
Prof: "Man, you guys are boring. I knew when I didn't get any questions after the midterm that you were low-key, but...anyway, there are about 5 grams of trans fats in a bagel, 10 in a McDonald's McMuffin. You're only supposed to have 2 grams, max, a day, so after one McMuffin--bam--you're dead for a week."

Limericks (no, not from Ireland...less dirty)

2008-11-01T01:35:00.000-07:00

For Table 10

There was an anatomy table
That quite simply did not seem able
To dissect with the speed
The professors decreed;
in the end, the stress made them unstable.

Standardized patient--failure

I entered the room with a grin,
Asked the patient, "So how have you been?"
HPI and exam,
then I thought, "oh g*ddamn,"
because I forgot to foam in.

Upper and Lower Limbs

I've been studying muscles for weeks,
lumbricals down to gluteal cheeks.
Can't learn one more insertion;
Such crazy exertion
can't help but reduce me to shrieks.

Histology

I can use a microscope well.
Preparing a slide? That's just swell.
But then point out some bug,
and I'll say with a shrug,
"I can tell you it looks like a cell."

Pelvis and perineum, you say?

2008-11-01T01:18:00.002-07:00

Yes, sex has officially become boring. Not just because it's been reduced to memorizing the branches of the pudendal nerve, the difference between the corpus spongiosum and cavernosa, and the inferior hypogastric plexus. No, (oversharing alert) I've also started to feel the effects of the massive quantities of Zoloft I'm taking, which means that while I'm not having panic attacks every day, nor considering jumping onto the Metrolink tracks, I am also somewhat lacking in the libido department. Granted, looking at all the photos of rectovaginal fistulas and elephantiasis of the scrotum in anatomy lecture may not have been the most...titillating, either.

Anne, I hear you saying, you write about anatomy all the time. We almost never hear about physiology or histology; sometimes you write about biochem or a selective, but rarely. Is anatomy really that big of a time-suck? Does it really weigh that heavily on your mind? To which I answer: yes, dear reader. Yes, indeed it does. And the bitch of it is, you really do need to know it. It's not like, say, some of the more esoteric histology and biochem lectures, where one could argue that the majority of physicians aren't going to need to know about post-transcriptional modification of mRNA in their practicing lives (if ever...ok, maybe at a bar trivia night, but then again, there was never a damn question at Lew's trivia night--In KC--that I knew by virtue of being a hoity-toity neurosci/German studies major. Mostly it was about sports, and weird/arbitrary 'pop culture'--so you know my scores were always in the crapper. Add to that the fact that it takes one--count it, one--Bud Light to knock me on my ass, and there you have it: the reason I never won 50 bar dollars. In Ithaca, on the other hand, the questions were of...ahem, pardon me while I have a snobby, elitist liberal moment here...a higher caliber, and the Telluride group always cleaned up nicely. I spent a bare minimum of my own money at The Chapter House. Good times).

In the course of my studying, I have come across a handful of words that I've fallen head over heels (make that cranium over calcaneous) for, and here they are:

acetabulum: where the femur (thighbone) articulates (connects) to the innominate (hip bone). Sing it with me...the thigh bone's connected to the acetabulum...

infundibulum: a cavity opening either into a tube or into the outside world; there is an infundibulum in the right ventricle of the heart, one in the fallopian tubes, and one in the shaft of every one of your little hairs.

Don't they just sound like Harry Potter words, like mad incantations? Can't you see Hermione Granger shouting, "Infundibulum!" and laying out a Death Eater? Can't you see what a huge dork I am, augmenting my dorkiness further by referencing a children's fantasy series in relationship to anatomy?

poetry alert

2008-10-27T01:14:00.000-07:00

Memento Homo Quod Cinis Est
(Remember, O Man, that you are Dust)

Standing in the dissection suite,
scrubbbed and gloved
(as if latex were protection
from the knowledge of one's own mortality)
I map out veins and tributaries,
tease out secret nerves
and contemplate the possibilities
of the awful glory of God
made manifest even here.

Skinned one,
Dismembered kindred, I too
have had someone
saw through my pelvis; I have been
the lovely assistant
split in two,
still smiling as the blood begins to flow.
I too have had someone finger my heart,
probe the chambers and valves,
Squeeze it like a child's toy and not
the seat of the soul that it is, that delicate tether
Binding body to earth.

Today we skinned your left hand,
removing a lifetime of jingled quarters
and turned pages;
today we stripped away
the last time you held your wife's face in your hands,
those familiar caresses as much a part of you
as that thin skin,
those ridged white gloves.

Despite the things
that have been lost,
the loves and longings wrenched
from between my fingers,
I am still able to hold on; am not yet
so far beyond the grip of grace
they might not be restored, or found anew.
I covered you, washed my hands, and as I washed
said a small prayer of thanks
for my small life,
and yours.

Stigma

2008-10-20T19:34:00.000-07:00

Today in one of my 'selectives'--sort of "extra" cool little classes that you take on the basis of interest rather than...how do you say?...requirement--we had several presenters speak on mental health services in St. Louis, and on the failings of infrastructure and policy in the American mental health system generally. There was also a discussion beforehand (with the 'coursemaster'--I love that term; it makes me think they should be wearing wizard robes and brandishing a staff, shouting, "Behold, I am the coursemaster!") on the stigma associated with mental illness, and the extent to which that's a barrier to people who would otherwise benefit from mental health services.

Stigma. The word itself means 'mark.' "Stigmata" are the markings of the crucifixion; someone with a contract on his head is a 'marked man'; Cain was stigmatized, marked, after he killed his brother Abel. Believe it or not, there wasn't always such a stigma attached to madness in Western society (I say madness only because that's what it was called back then; there are no medieval texts on 'mental illness.' Trust me, I wrote several loooong papers on this in the process of getting a German lit degree in my former life as a student of the humanities). Sure, some societies still thought that the mentally ill were possessed by demons, but an equally probable explanation was that the individual had been touched by God. Craziness was actually a good deal better tolerated then (by which I mean during the Middle Ages/Renaissance--read Michel Foucault's fabulous book "Madness and Civilization" to see what I mean). Then again, everyone and their dog had neurosyphilis back then, so maybe the bar for psychiatrically normal was a little lower, too.

Now, of course, psychiatry works with the laudable goal of alleviating human suffering; it also (sometimes) works with the much less laudable goal of making everyone maximally productive and optimally functional within the confines of a society that I think most enlightened and sane individuals would agree is inherently crazy-making...and while there have been some shifts in attitude even in the last twenty years (celebrities can speak frankly about substance abuse problems and battles with postpartum depression; mainstream sitcoms feature characters on antidepressants) there's still a lot of work to be done when it comes to acceptance of mental health issues.
The last time I was getting my car fixed (I always take it to the same shop--the owner is the father of a friend I had in elementary school) I mentioned I was going to medical school, and that I hoped to become a psychiatrist. My friend's dad took this as an invitation to expound on the virtues and failings of psychiatry as an institution, and more specifically the ways he saw psychiatric diagnoses as misplaced--as attempts to excuse moral deficiency or dodge responsibility:
"I think bipolar disorder is just another way of saying someone doesn't want to take responsibility for their actions...that they're immature."

I literally didn't know what to say, and not just because I'm (medicatedly) bipolar myself. It's that sort of attitude, that refusal to recognize that a disease is no less real because it manifests in the brain rather than in the pancreas or heart, that makes medical faculty and students deride psychiatrists as "not real doctors." That's the attitude that keeps a man from going to his physician with his suicidal ideations, for fear of being thought weak; that makes someone push and push and push themselves, a la Sisyphus, to run the mental equivalent of a marathon without pausing to consider that their anxiety or depression is the mental equivalent of a broken leg, and needs treatment equally as urgently. All right, I recognize that last sentence was awkward and clunky, and that's my cue to go to bed.

Let the games begin!

2008-10-13T06:15:00.000-07:00

In high school, I wasn't sporty. In middle school, yes, and in college, but not in high school.

I had band letters and academic letters (and debate) for my letter jacket, but no sports. So it struck one of my teachers as particularly funny when I described finals as "my Olympics." Seriously, I practically ran around the school in a tracksuit and headband emblazoned with "pi"--shouting, "1,2,3,4, I know what adrenal glands are for! 5, 6, 7, 8, and who won the Lincoln-Douglas debate!" DORK. Then as now, though now I am comfortable with and embrace my dorkdom. The popped collar and Chanel handbag contingent can be who they are, but I am who I am--someone who thinks enzymes and cell structures and clotting factors are pretty damn cool.

So, kids, I'm about to go do the first leg of this week's Olympic marathon--that is, midterms. MFM (which you may remember as "biochem, but interesting," not least because the prof is awesome) is this morning, in approximately half an hour. I've studied, as Holden Caulfield might say, "like a bastard," and I've gotten a good night's sleep (OK, a slight exaggeration, seeing as I never have 'a good night's sleep,' but as good as I ever get) and had a hearty oatmeal breakfast, and I'm wearing my lucky shirt. We do what we can. Let's see who comes out on top--me, or 100-odd questions about enzyme kinetics and metabolism. For once, I'm actually NOT nervous. But that could very well change in, say, 25 minutes or so.

A standardized test?

2008-10-08T20:52:00.000-07:00

We had our first standardized patient session today, something for which I felt woefully unprepared. It was supposed to focus primarily on communication skills and history-taking (right up my alley, no? You'd think...) but there was the addendum of the physical exam that made everyone a little...squirrely. Nervous, edgy, though of course everyone does their best to hide those things (I can't be the only one hyperventilating, can I? Of course, maybe I can). Some of the things we were supposed to know how to do hadn't been covered in our small groups at all; the best summary I can give of the 'musculoskeletal exam' I was taught would be, "Have them move things around and see if it hurts. Then you move them around and see if they hurt. Also, there are lots of bony landmarks you should be aware of, and everyone hurts their ankles and knees at some point so you should probably know what to do for those sorts of injuries." Standardized patients, by the way, are actors who are paid to come in, sit in exam rooms, and serve as fake patients. They give the histories from the scripts the medical school provides; they act out all the physical findings you're supposed to see (limps or tenderness or stiffness or whatever). The woman today was quite convincing; I found myself actually worrying that I might be hurting her. Some standardized patients really get into it deep, from what I've read: here at this Slate article I learned there are even those who let medical students try out their newfound pelvic exam skills (there's. not. enough. money. in. the. world. to make me do that).

We weren't even being graded, per se, on this encounter; I really shouldn't have been nervous. But we were kept standing outside the little exam rooms for almost 5 minutes, just giving us time to get more worked up (of course, some people would see this as time to 'collect their thoughts,' I suppose--cognitive restructuring, man, make it something positive!), and suddenly as I went in I could feel my face go numb and everything sounded echo-y and yes, I did a focused history and exam, and I didn't drop the stethoscope or lunge at the patient to feel her posterior lymph nodes (nothing like putting your hands around someone's neck without giving them warning), and I did wash my hands before and after thankyouverymuch, since failing to practice good hand hygiene is one of the few ways you can actually fail an encounter. I can't say too much more, since not everyone in my class has had their standardized patient experience yet (and there's an honor code saying you won't pass on information, that the exam suite is a secure testing environment, lah ti dah), but my patient did tell me that I "didn't do terribly at all," which hardly sounds like a ringing endorsement--but wait.
"You were just so nervous. I could feel your hands shaking as you were taking my pulse." Oy veh. But she went on: "You really have the personality for this. I can tell you'll be great at this, you just need to get over your nerves and then you'll be fine." Which I know is true; when I worked with Dr. B. doing preliminary interviews of his patients, they always told him 'what a nice girl' I was. Never mind that a 20 year old isn't really a girl, or that they were mostly geriatric patients who really needed someone to talk to, even if it was an inexperienced college student taking down their past medical history and medication information (but who was also willing to listen to them talk about their fears, and their grandchildren, and their gardens). Their bar for 'such a nice girl' wasn't very high, is what I guess I'm saying--just someone to smile, and listen, and care a little. Everyone needs to feel heard. Maybe that's what I need to focus on...maybe if I focus on that connection, everything else will fall more easily into place.

First anatomy exam

2008-10-02T21:26:00.000-07:00

The first anatomy exam was, in fact, less of a debacle than I expected it to be. Of course there was test-anxiety galore (for everyone--enough to take me out of my shell and spontaneously fear/anticipation-hug two people in the hallway outside the dissection suite), and the test itself, well, it was engineered for maximum fun--if you were a professor watching, I guess. It's what I'd imagine a social psychologist would arrange to look at the effect of stress on anal-retentive, type-A individuals.

Put 30 of them in a room at once, where they can see each other scrambling and scribbling (or, if they get to a question they do know, standing idly and making everyone nervous because obviously that kid knows everything and I don't know anything and he's going to end up head of neurology at Brigham and Women's and I'm going to have to go live in a box).

Have at least 5 parts to every question. Incorporate as many different colored strings as you can into the question--the same goes for colored pins. If you have large and small pins in the same color, use both of them (I spent 30 seconds on one of the questions yelling in my head, "There is no mother #$*^ing large white pin!")

If you pin an organ that's easy to identify, make sure that identification of said organ is not a question for which students may receive points--rather, ask about vascular structures associated with it, or disease states, or its embryonic origin (that'll show the little bastards to skip embryology lectures).

Allow only 2 minutes per question. Use a buzzer to indicate the 2-minute intervals. Make it loud, so as to destroy concentration and work anxiety up to a fever pitch. If you have a student with long Q-T syndrome, see if you can put him into fibrillation with the combination of stress and buzzer. While not quite as dramatic, you may also be able to get someone to hyperventilate or faint.

Actually, while I'm speaking tongue in cheek, the anatomy exam was tough but fair. Nothing especially esoteric or ambiguous was pinned; there weren't any questions that were nebulous. There was even a 'rest stop' during one of the 2-minute periods with a bowl of small candy bars (proof that I'm "in the army now"--I took one of the candy bars and ate it. Outside lab, of course, but still...as one of the other students said, "Dude, that's dissection suite candy." I just think it was very nice of the TAs/profs to bring it in). And I passed, well above the requisite cutoff, thankyouverymuch, and when I picked up my paper (It may have been a little obnoxious, but I don't apologize) I did a little jig in the hall.

And now it's time to start studying for midterms, week after next. Oh joy. But seriously, there's nowhere I would rather be than here.

Fistulas and atresias and surgery, oh my!

2008-09-26T20:15:00.000-07:00

So I'm learning about all kinds of cool (but sad) defects that can occur when there are failures in embryonic development--things that don't close that are supposed to close, things that close when they aren't supposed to, or close in the wrong place...

Considering all the things that can go wrong, as I've said before, it's a miracle any of us make it. There are duodenal atresias, where the intestines just stop (ending in a pouch) after the stomach...obviously, that's life-threatening; there are fistulas (ie, communicating tracts that shouldn't be there) between trachea and esophagus sometimes, which means you can get air in your gut where it shouldn't be (not that big of a problem) or food in your lungs where it shouldn't be (obviously a much bigger problem).

Then there are all the fistulas and atresias (atresia=something isn't there, or is blocked off) associated with the, ahem, genital and rectal region. I'll just say that the picture of a recto-vaginal fistula that I saw in lecture today is something that will probably be with me for a long time, haunting my dark moments. There's also something called imperforate anus, which is exactly what it sounds like: no anus. Just born without one. The large intestine doesn't go all the way down. I don't know why, but those were particularly 'what the hell?' pictures for me too--I mean, you hear all the time of people having heart defects, or spina bifida, or whatever, but no anus? I mean, c'mon, Mother Nature, quit having those three-martini lunches and get with the program here. There's a fairly standard design for a human body. Let's stick to it and not be adding or subtracting ESSENTIAL parts, shall we?

There's also something called gastroschisis (which I probably misspelled--Google it and check on me, since my brain is so full of anatomy right now that I don't have room for petty things like spelling or grammar) where a baby is born with intestines outside the body wall. Just hanging out there, chillin, as if they were on the front stoop with forties and cigs. And what's the solution, you ask? It's so simple I didn't believe it at first, but the pediatric surgeon said: "You just keep them in the hospital a few days, keep the intestines enclosed in a plastic bag so they're moist and protected from bacteria, and then roll the bag down like a tube of toothpaste." Like a tube of toothpaste, I swear to Goddess that's what he said. And gradually the body wall expands to encompass the intestines, and they all fit in there eventually, and the kid gets sewn up and gets a surgically-made belly button and everyone's happy. It really is amazing that after a period of a few weeks what were these tremendous, striking abnormalities could be almost completely resolved...that's the appeal of surgery, I guess: quick fixes. You do something, and you immediately see results. The inflamed appendix is gone and the patient recovers. The intestines go into the body wall, the blocked artery gets bypassed, the compound fracture is reduced and set. Psychiatry is on the complete opposite end of the spectrum, but somehow I think it's edifying in a different way. After seeing those pre-and post-surgery pics, though, I guess I understand a bit more why surgeons rag on psychiatrists. Of course, then the psychiatrists get to retort with hypotheses about God complexes and sublimated hostility and aggression. So everyone has fun.

Ativan, much?

2008-09-17T21:11:00.000-07:00

So last weekend was our first official quiz in Molecular Foundations of Medicine (ie biochem).
The first time I went to take it (I was really hoping to only take it once, but we're allowed to retake them once if necessary, which turned out to be a very good thing) I totally psyched myself out. I was concerned with making it the best possible time to take it--that I'd gone for a run and had the post-workout sense of well-being, that I'd had a protein/carb snack to get those neurotransmitters in top shape (speaking of which, I really need to start taking my fish oil again--those omega 3s and 6s really are good for brain function, as I'll prove to you by posting a link to an actual scientific article when I can be assed to do it), that I'd had the optimal nicotine to caffeine ratio--not so much as to be jittery, but enough that the neurostimulant effects were out in full force. There was an article in the NY Times recently that said caffeine has both mood elevating and cognitive enhancing effects--to which any college student or working person will respond with an exasperated "duh."
So I put on my white noise machine to block out the workaday sounds of my apartment complex (and my roommate, who had family visiting) and sit down to take the quiz online. Yes, it's online. Closed-book, do-it-alone, online. I don't know how many of my classmates actually did it that way; I don't know if the professor is really that inherently trustful of human nature (though one would imagine that with 40 plus years of experience on planet Earth she must have considered the remote possibility that driven, type-A people, which medical students are almost by definition, might...bend the rules) but I did the quiz myself, just me and my computer, and lo and behold--I bombed. I literally felt like I'd been gutshot. I went downstairs to get myself the beer I'd been planning to have (either in a congratulatory or consolatory capacity) and damned if my roommate didn't ask me, "Are you ok? You don't look so good." I looked over my answers--the program lets you review them after you've taken the exam--and I had clicked the wrong boxes, I had missed words in the questions...a fustercluck. I'd just been so freaked out; about halfway through, I started thinking, "This is the first thing that really counts. This will be recorded for a grade, for posterity. This determines whether or not you will be able to pursue your chosen career." And of course I froze, and screwed up. At the same time, the sane and rational part of me (it exists, despite the numerous neuroses I vent here and the voluminous evidence to the contrary) was yelling at this critical, needling voice: "Shut up shut up shut up for Chrissake shut UP!" Did I say sane and rational? Sorry.
So I spent part of Saturday considering whether I should call the dean Monday and go in to say, "I'm sorry, I'm too stupid to be here. Obviously there was some sort of mistake. I should probably go." But instead, I studied up a bit more, did some yoga and meditation before I took the quiz again, and lo: my grade went up 20 points. Which goes to show: there is not a single human situation that cannot be helped dramatically by chilling the eff out. In fact, I repeat it to myself, mantra-like, sometimes: Freak not. I've always imagined that if angels came to people nowadays, like they did back when Jesus was roaming around, they'd have updated their language--and instead of saying "Fear not," like they told the shepherds at the first Christmas, they'd say, "Freak not."
So the anatomy exam is in less than 2 weeks. It's on the 29th, a day that for various reasons is one of the crappiest days I can imagine to have to really crank out a good performance. I spent several hours today going over the material (ie, two days' worth of lecture notes...which means I only have another 5,000 hours of material to get through). For me, the real sticklers are the heart and the autonomic nervous system. First, just the idea of the autonomic nervous system: that my brain is getting up to things without me being aware of it (though I guess it's good I don't have to think about breathing or having my heart beat--hey, cerebellum and brainstem, I'm not being ungrateful, I'm just saying...). And the heart, well, there's just a lot going on, especiallywhen you throw embryology and congenital defects into the mix. But I'm sticking with my mantra. And taking Ativan occasionally.

A warning

2008-09-15T14:41:00.000-07:00

Do not fix yourself spaghetti primavera on a night you've planned to study the abdomen for your anatomy class.

Especially do not do so if you are planning to read and eat at the same time.

You will soon find yourself unable to do either. And after that, every time you see a mushroom, you will think of the spleen.

That is all.

Syncope is funny. Until it happens to you.

2008-09-14T13:42:00.000-07:00

So I fell out during anatomy lab on Monday. I wasn't anywhere near the cadaver--we hadn't even uncovered him yet--and I was just listening to the professor talk about the sympathetic nervous system. It was interesting, enthralling even, so it wasn't like I was short on sleep and fell into a mini-snooze (I was short on sleep, true, but also highly caffeinated...to the point of buzzing, in fact).
I remember what he was talking about--the sensory innervation of the diaphragm, and the tests they do for fallopian tube patency (they inject some air into the uterus, the woman stands up, the air leaks out the openings of the fallopian tubes and impinges on the diaphragm, and the woman sometimes feels a little pain in the region of her shoulders or neck...because the fibers that innervate the diaphragm actually arise at the cervical--read: neck, not the 'downtown' cervix--level. Which is actually good, because it means that at least the fallopian tubes aren't scarred shut, which is a fairly common cause of infertility). I had to sit down. Stood up again, sat down again. Went out into the hall, sweating and nauseous, and prostrated myself (note my cunning use of vocabulary to avoid the lay/lie difficulty--something I still don't have a complete handle on after all my years as what I would consider an English speaker of some facility) on what is probably one of the nastiest floors--make that nastiest surfaces, period--I've ever been privileged to make contact with. So of course one of the professors/lecturers/coursemasters/whatever the hell we're supposed to call them now happened upon me, which was probably good considering the fact that I was horizontal and still felt like I was losing consciousness. Why me, dammit? I'm not especially squeamish (though the bone saw did make me flinch). I'm not some consumptive Victorian who keels over at the first sign of stress or pressure. So what gives?
Anyway, it was an embarrassing albeit unique opportunity to be escorted to and chill on the floor of the prof's office for a few minutes, eat a granola bar, and get my blood sugar up into range (I've decided it was probably an, ahem, glycemic control problem, which is a way of conveying the issue without getting all up in my business). This was the coursemaster who scared the hell out of me at the beginning of the year; I still have a healthy respect-to-fear ratio, since she comes around the lab and fires questions like bullets ("And what's this structure here, just posterior and medial to the thoracic duct?" [Silence, as the table collectively tries to remember what medial means in this context]), but she's also phenomenal at explaining things and was quite nice when she could have just shipped me to student health or something. So there's that. And the fact that I almost wanted to say, when she asked me what was wrong, "I'm either having an exaggerated vagal nerve response to stress, a particularly intractable bout of orthostatic hypotension, or a brief period of hypoglycemia that will probably rectify itself once the epinephrine from talking to you mobilizes the glycogen stores in my liver." Maybe I'm learning some of this stuff after all.

The heart of the matter

2008-09-11T14:21:00.000-07:00

So we finally got to look at the heart. You'd think it'd be a fragile thing, especially after eighty-odd years of pumping, but at least in our cadaver it wasn't. I almost said 'specimen,' something some of our professors do from time to time...I'd like to avoid thinking of human bodies as specimens; for that matter, I like to think of even plant and animal exemplars as more than 'specimens'...to quote Mary Oliver,

"Is the soul solid, like iron?
Or is it tender and breakable, like
the wings of a moth in the beak of an owl?
Who has it, and who doesn't?
I keep looking around me.
The face of a moose is sad as the face of Jesus.
A swan opens her white wings slowly...
One question leads to another.
Does it have a shape? Like an iceberg?
Like the eye of a hummingbird?
Does it have one lung, like the snake and the scallop?
Why should I have it, and not the anteater
who loves her children?
Why should I have it, and not the camel?
Come to think of it, what about the maple trees?
What about the blue iris?
What about all the little stones, sitting alone in the moonlight?
What about the roses, and lemons, and their shining leaves?
What about the grass?
--Mary Oliver

His heart was thickened, as you'd expect perhaps in someone with heart disease; his left ventricle had been pumping against high blood pressure so long it was enlarged. When we cut the ventricles open, you could scarcely imagine they ever HELD any blood, the muscle was so hypertrophied. It was as if the thing itself had become so great, its function had all but been forgotten...how often does that happen?, I thought to myself. A cathedral becomes so glorious, overwrought with spandrels and flying buttresses and teeming masses of gilded figures, that the still, small voice it was meant to glorify is lost in the noise (of course, there are places--like St. Patrick's Cathedral in New York, or the Cathedral of Peter and Paul in Philadelphia--that are gilded and Romanesque but which do feel prayed in and USED rather than just admired...where the architecture feels like a solidified prayer rather than a distraction). A habit begins, to comfort and console, or perhaps to celebrate--champagne here, a cigarette to accompany a drink, five pounds lost to overcome a college freshman's feelings of ugly-duckling unbelonging. But it blossoms, and grows, and becomes more than it was ever meant to be, an ugly compulsion with a life of its own, the consoling or celebration or comfort lost in the cacophony of drive: alcoholism, addiction, anorexia.

So I have seen the inside of someone's heart now, the fantastic architecture, the membrane-thin walls of the atria and the thickened, hardy ventricles. I've seen the muscles that hold the valves in place, have run my fingers over the valves that even now are billowing diaphanously together in my chest maybe sixty times a minute (I'm always teetering on the edge of bradycardia--it's all the running). The valves are more like parachutes than valves as we think of them--phenomenally unmechanical, not at all stiff or thick (when they are stiff or thick, in fact, it causes problems and as such is labeled either insufficiency--if the edges of the 'leaflets' don't come together--or stenosis, if the valves are hardened and calcified). We're literally a few layers of cells away from dying at all times--it's amazing the ballet of our bodies doesn't get botched more often, that anyone manages to survive for any time at all.

What the hell is hemoglobin, you ask?

2008-09-01T17:14:00.000-07:00

This is heme. It's part of hemoglobin (well, actually just attached to hemoglobin, which from now on will be abbreviated Hgb, by the way), the protein that carries oxygen and carbon dioxide in your blood and ushers it where it needs to go. Gorgeous, no? The whole Hgb protein is even more impressive; this is just the metalloprotein accessory group that makes the whole shebang possible. See, Fe (iron) likes to bind oxygen, but oxygen likes to (duh) oxidize things, including iron. So what's an aerobically respiring organism to do? Bind the whole thing up in a protein environment (ie, the interior of an Hgb protein--not a molecule, by the way, because it's made up of four individual parts. It's called a tetramer, from tetra for four--again the geniuses with the dead languages thinking no one will know what they're up to) where oxygen is prevented from oxidizing anything. Seriously, google hemoglobin. I urge you. Even if only to look at the pretty pictures. Just think--right now YOU are producing that. You, sitting there in front of the computer with your bag of potato chips (and, somewhat ironically, a diet Coke) are spinning out these amazingly complicated, intricately turned proteins. Damn. More on the coolness of Hgb to come.

The Thorax

2008-08-31T11:00:00.000-07:00

It sounds like a Dr. Seuss story, doesn't it? Anyone remember the Lorax? Anyone?
But it's not...no Sneeches, no clear-cutting, no Grinch. Just the human trunk--the thorax, which is what we're currently looking at in anatomy.

On Friday we opened up the rib cage to get at the stuff inside. It was simultaneously fascinating and off-putting in that 1) It's not every day you get to look at real, honest-to-Buddha lungs and hearts, but 2) It's also not every day that you go at a human body with a SAW. And bonecutters, which are essentially larger and more specialized versions of wire-cutters. And in a way, it did feel like to sort of breaking and entering people generally get up to with wire-cutters (I can't say I've ever heard of anyone using wire-cutters for anything respectable, thought I'm sure it must happen--It can't all be stealing bikes and getting into chain-link fences). Instead of entering someone's compound, however, we were entering someone's chest. I was elected by our group to do the first few cuts of the ribs (again with the if-you're-squeamish-skip-down-a-bit warning) and I have to say, it was hard work, and made a sound that could be described as either disgusting or highly satisfying, depending on your bent. The clavicles and xiphoid process (the end of your sternum) we went after with a saw, since apparently they're too tough for even bonecutters to work (yes, it was essentially a saw just like the kind you'd use on wood, with the exception that it was bright yellow and due to someone previously doing a less-than-stellar cleaning job had bits of...something organic on it). I'll admit it made me a little woozy, and I handed over the cutters as soon as I'd done my requisite couple of ribs.

I didn't actually see the heart; it's covered by pericardium, really very well veiled by filmy white tissue, which seems appropriate--who wouldn't guard their heart a bit? Don't we all do that, not just anatomically but metaphorically and emotionally? The lungs were on full display, however, with their covering of slippery, whisper-thin pleura, and as springy and pink as the various preservative solutions would allow (soft tissues have a tendency to harden in the presence of preservatives, which is advantageous in many ways but not so great in others). One of the neighboring tables' cadavers was a long-time smoker...needless to say, there were dark spots all over and the lungs weren't nearly as pink and spongy as ours. Perhaps medical school will finally cure me of my smoking addiction once and for all--nothing like looking at the actual, physical results of your particular vice to get you to "straighten up and fly right," as my father would say.

overwhelmed? who, me?

2008-08-27T19:40:00.000-07:00

Not by courseload, necessarily, but by sheer volume of information. Each class is actually multiple classes, with multiple sections: one course is comprised of physiology and histology together (and histology is both a lab and a lecture course); anatomy is a lab, and a lecture, and has some radiology thrown in for good measure, and the 'doctoring' course has a seemingly infinite number of sections, subsections and small groups. In a few weeks I'm sure I'll be fine; for now, I'm basically just buzzing with a combination of excitement and anxiety.

Not to mention the information our instructors are actually trying to convey to us INSIDE lectures and labs--and the fact that while some of it is hard and fast (insert your double entendre here) a lot of it is open to interpretation--for instance, when one of our anatomy instructors looked over our cadaver today and told us,

"I'm going to say that's the deltoid branch, but someone else might tell you it's the clavicular, and really it could be either." (Yes, I cut an artery by mistake and then we couldn't tell where it was supposed to be branching. "You're going to cut important things," she added. "It happens. Some people get really bent out of shape, but if you just expect it to happen, it's not that big a deal." What? Someone not advocating rabid perfectionism? Hot damn, I did come to the right school!) Same in histo. "Is that a macrophage?"
TA: "It could be. It could also be a plasma cell; it's not a textbook example of either one, though."
What I DON'T say: "So how helpful is the textbook then? And how can anyone ever be sure--like pathologists? Let's talk about the epistemology of the macrophage and the illusory nature of nomenclature and classification."
What I do say: "Also, could you tell us what this structure is? It's not in the lab manual."
TA: "I have no idea."

I kid, I kid. The TAs are great, the instructors are awesome, and I couldn't be happier to be here. It's just that enzyme kinetics AND all the structures of the thorax AND the classification of cartilage, bone and epithelium AND biostatistics (even though it's not called that) AND how to take a history and physical...all at once...is a lot. Check in with me again a week before midterms and no doubt I will laugh at the naive and spoiled me of August who wrote this entry; but here it is.

Cadavers, Humanity and Faith

2008-08-25T22:21:00.001-07:00

So our first day in the anatomy lab was today.
Today I made my first incision into another human body.
It was at once sobering and exciting, this rite of passage, a threshold every future physician has to cross and probably remembers for the rest of her life. It was also just incredibly, utterly cool.

The face, hands and feet--probably the most human parts of any body--were covered with stockings, both to make it easier for us to do what we had to do and to protect them from desiccation.
The body itself was that of an eighty-ish man, who died of complications of heart disease; he was a middling-sized man, not the wasted habitus you sometimes see in old age or advanced infirmity, but not huge. I thank him for his gift to my learning.

We began by cutting flaps of skin on the chest and reflecting them back, then working away the fat until we could see the superficial fascia (tough coverings) on the pectoralis major, serratus muscles, and deltoids. There was a fair amount of fat to cut away from the ribs; we worked a little too far inferiorly and ended up exposing a little bit of the rectus abdominus as well (the abs, for those of you with any passing familiarity with SHAPE magazine et al). I never realized how much fat there is in the average body--not just in a large person, but in a person period. It made me feel a little better about my latest body composition stats. The people with female cadavers sectioned the breasts to get a look at the lobules and such that comprise the milk producing tissue--no one found much, considering that most of the donors were fairly advanced in age and the lactation apparatus etc. sort of atrophies (ie shrivels up) with age--nature is quite parsimonious, and what you don't need you generally don't keep. One group did have a female cadaver with breast implants--I lacked the wherewithal to actually handle one, first because I think breast implants are gross in general, second because (spoiler alert, if you're squeamish skip to the next paragraph) they were covered with grease from the aforementioned abundant fat.

It's difficult to walk the line between remembering that these were once human beings aand as such are inherently due respect and compassion (and depending on your religious and moral bent, still are people--I got called out on this at the Christian Medical Association meeting, where one of the participants 'reminded' me that "They aren't people anymore--the soul has departed, they're corpses." I'll write more on the CMA later--it's not the best fit I could have hoped for, as it seems populated primarily by mainline and right-leaning Protestants that would probably have heart attacks if they knew the extent of my interfaith Episcopal/Quaker/Wiccan/Buddhist hippy-dippiness. However, they're nice folks, and when I go to their meetings they feed me, and the lingo--"glorify the Lord," "the things of the world," "being a witness for Christ"--reminds me of the church I went to in elementary/ middle school, which is simultaneously comforting and kind of painful) and jsut focusing on the anatomy, doing what you need to do, and forgetting for a little while that you're working on a person. Selective attention, I guess you could call it, or selective numbing. You can only focus on so much, and while of course I never want to treat anyone or any body (pun intended) I meet as just a hunk of flesh, for the purposes of this course I think I'm going to have to depersonalize the cadaver, at least a little, at least for a while.

Anatomy, Day 1

2008-08-25T04:01:00.000-07:00

So today's the first day of anatomy, and I have 3 primary goals for today (I always knew those goal-setting seminars I went to in high school would have a purpose beyond giving the counselors work to do and me a way to get out of class):

1. Don't hyperventilate, pass out or throw up in the anatomy lab. I'm usually not that squeamish--I watch the surgeries on Discovery Health on occasion (at least at my parents' house, the only place I've lived in the last year that had cable), but there's a big difference between sitting on the couch with a bag of pretzels and actually being gloved up standing next to a no-longer-living person. More on this later, no doubt, after I've actually done my first day.

2. Don't cut myself, or anyone else, with the scalpels. I'm talking accidentally, of course--It's not like I'm going to have to be restraining myself from spontaneously dissecting my tablemates (although I've heard that, as a profession, medicine harbors one of the largest percentages of serial killers. Creepy, huh? I guess it's the combination of God Complex, poor pedagogy that presents the body as a piece of meat rather than a human being, and the sort of cunning--and I use that in the nicest way, just to mean 'smarts'--that drives people into this particular calling).

3. Manage to get changed and spritzed with perfume (to cover up the eau de formaldehyde I'll doubtlessly be exuding) in time to meet my clinical preceptor on the inpatient unit this afternoon. From anatomy scrubs to clinic-ready wear (which kind of feels like drag, to be frank...but more about that too, no doubt, as time goes by) in forty-five minutes, with time for a lunch talk from the AMA in between? I think I can. I know I can. I am the little train that could.

Medicine and the humanities meet...and the result is poetry

2008-08-23T17:15:00.000-07:00

This morning

Walking down Euclid, that name
which puts me forever in mind of angles and arcs,
I saw a young boy walking with his mother,
'Spastic,' the official term,
so monstrously unfitting:
His arms were kept
clenched closely to his body,
As if he were cradling himself;
His face was like an empty plate,
that youthful newness
still aching to be piled with good things--
Skin china-fine, and equally as pale,
through which I could see his bones
and the meandering tributaries
of his veins.
His geometry was warped,
angles acute,
The delicate spine's arc
twisting to the right--
and yet he walked on two
straight, honest legs
past me and on
into the morning light.
-AG

I sing the joys of biochemistry

2008-08-19T18:18:00.000-07:00

Today was our first official biochemistry lecture--or, as it's called here to make it sound clinically relevant and less like a rehash of that class you took during your killer 21-credit-trying-to-get-into-med-school-junior-second-semester, "Molecular Foundations of Medicine."

There was the "two semesters of gen chem and organic chemistry and biochem--each" crammed into an hour, and then we talked about prions and prion-related diseases, which are actually pretty cool. People thought Stanley Prusiner was a total whack job when he first said, "Hey, these aren't viruses and they aren't bacteria--maybe they're just misfolded, infectious proteins." I would imagine they told him, "Stan, you're a misfolded protein." But now that guy down the hall who made fun of him when his paper was rejected hangs his head in shame every time he's reminded of those comments, and Stanley has a Nobel Prize, so ha freaking ha. Chase your dreams, kids. Don't be disillusioned.

We also had a Practice of Medicine, or "Doctoring" class, and got to watch a sample interview/physical, where we learned such gems as (I'm actually not being ironic--moi?--some of these were things I'd never even thought about, or had thought about but will likely forget when I go in for my first interview smelling of sweat and hand sanitizer and fear):

-Introduce yourself, and sit down. Studies have shown, one of the clinicians noted, that when you sit down with patients they feel like you've spent more time with them, and hence they are more satisfied with the whole experience. Also, you're not towering over them (not that my 5'4" self would be doing much towering) and even further emphasizing the power imbalance inherent in the relationship.
-Tell the patient what you're doing before you do it and as you do it. Don't lunge at people without explaining what's going on. With adults, you'll make people uncomfortable; with pediatric patients, you might get bitten.
-Listen. What a concept. Don't barrage the patient with questions. Segue to the topics you want to cover in a SMOOVE manner. If you're good at macking on people, apparently, you will likewise be good at getting histories. Please don't mix the two and mack on patients, by the way, especially if you're an OB/GYN. Because it's not just creepy, it's an ethics violation.
-Wash your hands.
-Warm your stethoscope and hands. And if you're using one, the speculum (since I'm 99.9% sure I won't be going into OB/BYN, I'll say this simply as a woman...there is nothing like a cold speculum. And not in a good way).
-Ask follow-up questions. Ask people to clarify. "I used to party..." could mean anything from getting funky with birthday cake and those paper cone hats to snorting crystal and having sex with other men. Obviously one is a risk factor for a lot of things, and the other isn't so much (OK, maybe diabetes if you eat a LOT of cake).
-Related vein: don't assume risk factors--or anything, really--based on appearances alone.
-Wash your hands.
-Be friendly. Smile. Say please a lot. This person is giving you access to their life history, their secrets, their body. Be compassionate and polite.
-Wash your hands.

Oh, yes, in histology yesterday we had our first "Joke at the Psychiatrists' expense."
"As for the people who never learn to identify anything under the microscope, we just hope they go into psychiatry or something." I wanted to say, "Really? This early you're hating on the psych folks? REALLY?" I guess everyone just pimps everyone else and I should get used to it, but come on now. It's a little early to be establishing pecking order, isn't it (I say "establishing" as if psych weren't sort of entrenched towards the bottom...but at least people TALK to them. Pay quite a bit to talk to them, in fact. Let's see any other kind of physician, even a sparkling conversationalist, who gets paid just for their words).

And So It Begins.

2008-08-15T19:11:00.000-07:00

I've just finished orientation at a certain well-known and fairly prestigious medical school in St. Louis. The white coat ceremony was today, and I have to say I enjoyed it; we read the oath we (as a class) crafted, stating our intent not to shaft our patients, our faculty, or each other, listened to several speakers tell us 1) how awesome we are 2)how awesome Wash-U (damn, I let that slip) is, and 3) that there are wonderful benefits--and grave responsibilities--that come with being a physician.

Somehow I am anticipating that the "y'all are fantastic!" may not carry very much farther into the semester, so I aimed to enjoy it while it was available. Then again, I have a tendency to anticipate the worst and expect people to turn on me without warning or provocation, so that could just be my own neurosis speaking.

The following are some quotes that sum up what this week was all about for me.

"Hi, I'm X. What's your name? Where are you from? Where'd you do undergrad?"-everyone
So I learned that people here are friendly, outgoing, and in some cases (although I think I only met one...) eager to let someone know they went to Harvard.

"If you fail an exam, I'll know, and we'll have a warm and fuzzy chat about how you're doing."
-One of the deans
So it seems people here aren't primarily interested in nailing you to the wall, but rather in ensuring you do well and checking in with you if you're not. I pray to Christ, and Isis, and Buddha, that I don't ever have to have a "So you're screwing up academically" warm-and-fuzzy-conference; however, the overall feeling of someone watching out for you--not in a creepy, Dick-Cheney-who-would-put-cameras-in-every-American's-bathroom-if-he-could way, but in a caring sort of way--is reassuring.

"Additionally, if you have to be taken by ambulance to the ER for alcohol poisoning, I will know that too. And we will have a different sort of chat." -the same dean
Well, I'm on my ass after one drink. The probability that I would drink myself into ethanol toxicity is approximately as remote as the likelihood that all my electrons would suddenly shift phase and transport me to Aruba, a la the Philadelphia project (seriously, the whole Philadelphia project was really cool. Google it, please). Also, Dean X's knowledge and sight is truly without limit, and her reach knows no bounds. Who knows what evil lurks in the hearts of medical students? Dean X knows, and she will totally file a professionalism concern form on your ass.

"I woke up on X's couch this morning and didn't know where I was. It took me a full five minutes to figure out what the hell happened last night." -a fellow first-year
So apparently there are others with greater capacity for drink than I, and additionally our class has already begun to bond to the point that we're crashing drunkenly on one another's couches. That's the sort of camaraderie that I think orientation week is meant to foster, no?